Questions for Podiatry's Leaders

[619]

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We are always willing to sit at the table with them, we have many times actually. I think we could come up with a system that works better for the profession and is a fair assessment of competence for podiatrists.

Recently, we offered to meet with them without any pre-conditions.

But let me be clear that the ABPM is moving full-speed ahead with the CAQ and our defense of ABPM BC. We promote fairness, parity, and equity in podiatry.

Dear Dr. XXXX

Yesterday, you may have received an email message from APMA regarding the relationship between ABFAS and ABPM. We thought it best to clarify our position so that the community hears it directly from us. ABFAS is deeply committed to a strong future for the profession and repeats our stance that we are willing to meet with ABPM as soon as it withdraws its surgical CAQ.

- The ABFAS Board of Directors

 

[619]

I wonder who will be the first to fold

 

[Feli]

I wonder who will be the first to fold

Who has more money, 90% of the better minds of our profession (including nearly all program directors), much more history, more logical testing process that parallels MD boards? 🙂

 

[DYK343]

Dear Dr. XXXX

Yesterday, you may have received an email message from APMA regarding the relationship between ABFAS and ABPM. We thought it best to clarify our position so that the community hears it directly from us. ABFAS is deeply committed to a strong future for the profession and repeats our stance that we are willing to meet with ABPM as soon as it withdraws its surgical CAQ.

- The ABFAS Board of Directors

Got that email today too. Wonder what ABPM said about ABFAS other than the response that was written by diabeticftdr in the other thread.

Or is it the same response as written by diabeticfootdr?

 

[Feli]

Got that email today too. Wonder what ABPM said about ABFAS other than the response that was written by diabeticftdr in the other thread.

Or is it the same response as written by diabeticfootdr?

There have been a lot of digs on and off against ABFAS since the CAQ was announced... the main ones were in that "eating the young" email blast, yeah.

I actually expect this to get handled within ABPM at some point soon. The meeting that needs to happen is among that group itself. I can't imagine it's the collective ABPM consensus being spoken, and I don't know if they can wait it out for a leadership change at this point. A lot of their board of directors isn't ABFAS BQ/BC, but about half of them are... a couple are even RRA cert. I would imagine those "dual cert" ppl understand both sides, know the history and roles of the boards for testing and residencies and etc, and realize that inflammatory stuff and intentionally basing the ABFAS board (and SDN, and a lot of things) isn't productive. It will be a matter of when they get sick of the emails and newsletters being signed signed "we" and "ABPM board."

It should be plainly obvious why nobody wants to sit and reason with someone aiming to drastically change a board, overlap another board, create general inflammation, try to pin the applicant pool on SDN, and push new pods schools without the residencies to back them. Santa Clause might be in the crosshairs next??

 

[dtrack22]

ABFAS’ email might seem reasonable or genuine on the surface…until you realize much of the certification process was put into place by people like Mindy Benton who have less training/skills/diversity in terms of surgical practice than most of us who have recently been or are in process of being certified. With all of that in mind, they just sound like gate-keeping elitist pricks.

 

[Feli]

ABFAS’ email might seem reasonable or genuine on the surface…until you realize much of the certification process was put into place by people like Mindy Benton who have less training/skills/diversity in terms of surgical practice than most of us who have recently been or are in process of being certified. With all of that in mind, they just sound like gate-keeping elitist pricks.

No doubt... the process needs work. The old-school tactics of setting speed bumps for young and well-trained is not ideal. 👍

I just don't think having everyone pass an easy paper test out of training is the solution. That's reckless. Mainly, that's not what any MD surgical specialty does... they still sit for at case reviews and competency (even though they generally have more uniformly high quality residency standards/number than DPM residencies do).

Needs to be decent gatekeeping... doesn't need to take forever and be ultra-low pass rate.
It is true that the RRA cert will always be a bit rare, though... a lot of DPMs just don't do or don't even get those cases/refers (even if they have the training).

 

[HardRoadPaved]

a lot of DPMs just don't do or don't even get those cases/refers (even if they have the training).

Honestly for me....it cost me a lot of money for something with marginal if any benefit. Several thousand dollars in testing fees and the time.... Oh the time wasted with case review.

RRA cases pay me dogturd in PP. Woohoo $750-875 for an ankle fx and $500-600 for an Achilles repair. When you're in PP you also don't have residents to scrape cartilage for you when doing a triple.

 

[de Ribas]

No doubt... the process needs work. The old-school tactics of setting speed bumps for young and well-trained is not ideal. 👍

I just don't think having everyone pass an easy paper test out of training is the solution. That's reckless. Mainly, that's not what any MD surgical specialty does... they still sit for at case reviews and competency (even though they generally have more uniformly high quality residency standards/number than DPM residencies do).

Needs to be decent gatekeeping... doesn't need to take forever and be ultra-low pass rate.
It is true that the RRA cert will always be a bit rare, though... a lot of DPMs just don't do or don't even get those cases/refers (even if they have the training).

Residency training should be the biggest gatekeeper. MDs have high pass rates for their boards because their training is standardized and equal among all programs. Boards basically verify their competence. They don't test something that they were not trained, educated on in residency. In contrast, there is large gap between what pod board is asking for and what most residency programs offer. If CPME is responsible for standardization and quality of residency programs then they are responsible for failing so many grads. CPME approves ABFAS and ABPM (we heard this a lot on this forum) and it also approves residency training. Why CPME doesn't enforce residency programs to educate and train residents to meet ABFAS requirements?

When I was on off-service rotations we also attended their academics, board prep, presentations, journal clubs, etc. All other services significantly emphasize board prep. They go over board prep, board questions, board material, topics several times per week. Attendings daily, during rounds, teach their residents board material. None of the pod programs I have been at have emphasized or really taught board material. It was here and there but not board focused. Students and residents are pimped on often stupid, unrelated and/or useless topics. During IM rounds attendings ask/pimp and teach on topics directly from boards, high yield. Pod profession as a whole fails so many pod grads. CPME needs to step up and reanalyze residency programs and set standards on par with board requirements. Programs are responsible to educate, train and prepare their residents to meet current board standards. If programs are consistently producing residents not able to pass Boards and become BQ/BC, they need to be on probationary status or even closed. Or get RRA or surgical designation removed. Somethimg needs to be done.

 

[DYK343]

Residency training should be the biggest gatekeeper. MDs have high pass rates for their boards because their training is standardized and equal among all programs. Boards basically verify their competence. They don't test something that they were not trained, educated on in residency. In contrast, there is large gap between what pod board is asking for and what most residency programs offer. If CPME is responsible for standardization and quality of residency programs then they are responsible for failing so many grads. CPME approves ABFAS and ABPM (we heard this a lot on this forum) and it also approves residency training. Why CPME doesn't enforce residency programs to educate and train residents to meet ABFAS requirements?

When I was on off-service rotations we also attended their academics, board prep, presentations, journal clubs, etc. All other services significantly emphasize board prep. They go over board prep, board questions, board material, topics several times per week. Attendings daily, during rounds, teach their residents board material. None of the pod programs I have been at have emphasized or really taught board material. It was here and there but not board focused. Students and residents are pimped on often stupid, unrelated and/or useless topics. During IM rounds attendings ask/pimp and teach on topics directly from boards, high yield. Pod profession as a whole fails so many pod grads. CPME needs to step up and reanalyze residency programs and set standards on par with board requirements. Programs are responsible to educate, train and prepare their residents to meet current board standards. If programs are consistently producing residents not able to pass Boards and become BQ/BC, they need to be on probationary status or even closed. Or get RRA or surgical designation removed. Somethimg needs to be done.

I feel like schools should be the gatekeepers but anyone with a pulse gets a DPM admittance. Residency does some gatekeeping (maybe they will be the ultimate gatekeepers with the upcoming shortage in a few years!). Unfortunately ABFAS is our gatekeeper even if they have some questionable grading. CAQ is a backdoor certification and its really not protecting the public. Its endangering the public IMO.

Its easy to look in the rearview mirror being certified foot/RRA as the grading is questionable for a lot of people and certainly good surgeons fail that exam. But it is passable. Ive said it elsewhere before but I personally believe over documentation is the key to passing case review.

Honestly for me....it cost me a lot of money for something with marginal if any benefit. Several thousand dollars in testing fees and the time.... Oh the time wasted with case review.

RRA cases pay me dogturd in PP. Woohoo $750-875 for an ankle fx and $500-600 for an Achilles repair. When you're in PP you also don't have residents to scrape cartilage for you when doing a triple.

I agree rearfoot pays poorly - especially elective. Its really not worth doing it (esven more so if PP) given most of these elective RRA cases are trainwrecks. I dont mind doing rearfoot trauma. I typically got $1000 for a bimal medicare rates at my last job. Trimal was around 1300. I find ankle trauma to be one of the easier traumas there are (except pilon). I certainly struggle sometimes but most of them snap back together pretty easy.

But having RRA opens jobs IMO as I recently stated elsewhere on here.

 

[Boba Foot]

Who has more money, 90% of the better minds of our profession (including nearly all program directors), much more history, more logical testing process that parallels MD boards? 🙂

I respect your opinion and you post some of the more quality posts on here, but when only 30-40% of the profession (who aren't grandfathered-in old mustache pods) can pass said board's exams by financial design the "90% of better minds, history, etc etc etc" don't matter because they have driven themselves to failure and irrelevancy by greed and gatekeeping. It was only a matter of time until the majority of the profession called shenanigans.

Frankly speaking, ABFAS can get ****ed and they brought this crisis upon themselves.

 

[DPM TRUTH]

Congratulations ABFAS, you are forcing me (and many of my collegues in certain states) to do something we haven't done in decades - rewrite the podiatry bylaws at our institutions.

It was actually very simple, I simply replaced ABFAS with ABFAS/ABPM-CAQ for almost all procedures. Simple, thanks abfas for making this decision simple based on your desperate emails.

When the abfas gurus give me noise, I will show them their "abfas collegues" binders from 2003 case review. They have some nice k-wire fixation for their Austin bunionectomies the abfas credentialed woth a 2mm gap 8 weeks out. No screws, no trauma, no ankle work, but they are "board certified".

Some on here think think this is an "overblown problem". Is it a "overblown problem" when that grandfathered in abfas diplomat harms someone due their incompetence and lying about their credentials? Or should we just give him/her a pass because "they had to submit a couple of toes in 1991" for case review? Nothing to see here right abfas crowd, maybe time for another pointless email!

It's almost criminal to advertise foot and ankle surgery when you never touched an ankle in your life. How long is the abfas gonna allow their members to mislead the public like this? As long as the apma/cpme continues to allow them to is the answer.

Have a nice holiday and happy new year everyone, best wishes in 2023!

 

[icebreaker32]

Congratulations ABFAS, you are forcing me (and many of my collegues in certain states) to do something we haven't done in decades - rewrite the podiatry bylaws at our institutions.

It was actually very simple, I simply replaced ABFAS with ABFAS/ABPM-CAQ for almost all procedures. Simple, thanks abfas for making this decision simple based on your desperate emails.

When the abfas gurus give me noise, I will show them their "abfas collegues" binders from 2003 case review. They have some nice k-wire fixation for their Austin bunionectomies the abfas credentialed woth a 2mm gap 8 weeks out. No screws, no trauma, no ankle work, but they are "board certified".

Some on here think think this is an "overblown problem". Is it a "overblown problem" when that grandfathered in abfas diplomat harms someone due their incompetence and lying about their credentials? Or should we just give him/her a pass because "they had to submit a couple of toes in 1991" for case review? Nothing to see here right abfas crowd, maybe time for another pointless email!

It's almost criminal to advertise foot and ankle surgery when you never touched an ankle in your life. How long is the abfas gonna allow their members to mislead the public like this? As long as the apma/cpme continues to allow them to is the answer.

Have a nice holiday and happy new year everyone, best wishes in 2023!

Your repeated message is grandfathering. It is true and most are aging out. Do I have repeated messages? Certainly.

ABFAS is no longer the "gatekeeper" for hospital and insurance privileges in most areas, especially outside or ankle and major rearfoot cases.

The bigger issue is the job market. With supply and demand in the garbage for most organizational jobs there will continue to be some way an elitist group develops wether intentionally or unintentionally due to market forces. If you get close to 100 applications for a great job that look sort of similar on paper, you look for a way to weed out 90 percent of candidates. If not ABFAS, it will be fellowships or something else.

The pass rate for ABFAS should be higher. Either the schools need to increase their standards or ABFAS has to consider finding some way to increase the pass rate. For the case review process it can be improved. If many can not get enough surgeries after residency for cases, then we need to take a serious look at considering ourselves a surgical specialty or actually admit formally we are saturated.

For as much as you complain about grandfathering, ABFAS does not care who you know. I know some very well connected podiatrists that never were able to complete the process. It might have its problems and it used to seem like a club in the past when much less obtained it, but you have to earn it. The grandfathered are aging out. As far as harming a patient a podiatrist can get surgical privileges with only being board qualified and most often they can even maintain those privileges once on staff even if they never obtain either board. They can still obtain the "other" boards out there also besides ABFAS and ABPM and advertise with those.

If you feel strongly about the older grandfathered ABFAS podiatrists, then continue to make some noise, I suppose. I will continue to make noise that there is saturation and a less than ideal job market.

 

[Feli]

Residency training should be the biggest gatekeeper. MDs have high pass rates for their boards because their training is standardized and equal among all programs. Boards basically verify their competence. They don't test something that they were not trained, educated on in residency. In contrast, there is large gap between what pod board is asking for and what most residency programs offer. If CPME is responsible for standardization and quality of residency programs then they are responsible for failing so many grads. CPME approves ABFAS and ABPM (we heard this a lot on this forum) and it also approves residency training. Why CPME doesn't enforce residency programs to educate and train residents to meet ABFAS requirements?

When I was on off-service rotations we also attended their academics, board prep, presentations, journal clubs, etc. All other services significantly emphasize board prep. They go over board prep, board questions, board material, topics several times per week. Attendings daily, during rounds, teach their residents board material. None of the pod programs I have been at have emphasized or really taught board material. It was here and there but not board focused. Students and residents are pimped on often stupid, unrelated and/or useless topics. During IM rounds attendings ask/pimp and teach on topics directly from boards, high yield. Pod profession as a whole fails so many pod grads. CPME needs to step up and reanalyze residency programs and set standards on par with board requirements. Programs are responsible to educate, train and prepare their residents to meet current board standards. If programs are consistently producing residents not able to pass Boards and become BQ/BC, they need to be on probationary status or even closed. Or get RRA or surgical designation removed. Somethimg needs to be done.

Yes, this is the bottom line.

The residencies are far from uniform. Minimum competency and volume and academics and board prep are NOT achieved or low quality at many of them (outside a rare resident at a VA spending a ton of time in the library and doing self-study). It is to be expected that there are the lack of academics and teaching attendings with the rush to create many programs and to turn programs into 3 year ones circa 2000, but it's a failing nonetheless.

It also has a lot to do with many PDs being in pod private practice or MSG/ortho and not FTE of the hospital... time teaching is time away from $$$. That's another thing that is opposite the vast majority of MD teaching programs. I was at a program with a historically 100% ABFAS BQ passing rate for decades and a PD who was a full-time hospital employee, clerk/core students every month... and even there, we had to basically resident-run weekly Myerson review, McGlamry review (our PD and other attendings did lead radiology rounds, case presentations, M&M, bi-weekly). It can't just be dependent on having good verus lazy senior residents as to how much will or won't happen in terms of academics - but that's reason #462 to match a good program.

...It is shortsighted to come here and say that board pass rate for existing boards should be higher... or that new easier "surgery" cert/board should be fabricated just to have a higher pass rate. Don't lower the bar... up the training level. The new schools/grads will be detrimental in this regard (and for the job situation) if residencies are forced once again hastily or add spots.

 

[DPM TRUTH]

About the grandfathered in crowd "aging out". I agree, this group is not operating or actually seeing many patients anymore...guess what they are doing instead? They are "expert witnesses" for plaintiffs AGAINST collegues. Making tons of money doing it.

This is the premise that brings me to the forum. I'm sick of the old "dinosaurs" using their "foot and ankle certificate" in the courtroom against collegues. It misleads the public saying you are board certified in foot and ankle surgery when you never completed a surgical residency, let alone touched an ankle.

So yes, this deceptive move the "foot and ankle certified crowd" uses against collegues is wrong. I still am awaiting a response from cpme/abfas/apma about why they ALLOW collegues to mislead the public using the "foot and ankle card".

So yes, this is a problem and I can't understand why cpme/apma/abfas will not address it. They wanna keep their heads in the sand and "act like it is a small issue". It's not a small issue. It is a serious issue that is abused.

Easy solution...no more "foot and ankle certified". Either foot or RRA period. "Grandfather" the foot and ankle crowd into foot only. Problem instantly solved. Anyone wanna guess why "leadership" doesn't wanna address this issue with a 20ft poll?

 

[Pronation]

Anyone wanna guess why "leadership" doesn't wanna address this issue with a 20ft poll?

T. rubrum associated delirium caused by excessive mycotic nail dust inhalation?

 

[icebreaker32]

About the grandfathered in crowd "aging out". I agree, this group is not operating or actually seeing many patients anymore...guess what they are doing instead? They are "expert witnesses" for plaintiffs AGAINST collegues. Making tons of money doing it.

This is the premise that brings me to the forum. I'm sick of the old "dinosaurs" using their "foot and ankle certificate" in the courtroom against collegues. It misleads the public saying you are board certified in foot and ankle surgery when you never completed a surgical residency, let alone touched an ankle.

So yes, this deceptive move the "foot and ankle certified crowd" uses against collegues is wrong. I still am awaiting a response from cpme/abfas/apma about why they ALLOW collegues to mislead the public using the "foot and ankle card".

So yes, this is a problem and I can't understand why cpme/apma/abfas will not address it. They wanna keep their heads in the sand and "act like it is a small issue". It's not a small issue. It is a serious issue that is abused.

Easy solution...no more "foot and ankle certified". Either foot or RRA period. "Grandfather" the foot and ankle crowd into foot only. Problem instantly solved. Anyone wanna guess why "leadership" doesn't wanna address this issue with a 20ft poll?

It is not right, but unfortunately at this point that ship has sailed.

 

[Feli]

...I agree rearfoot pays poorly - especially elective. Its really not worth doing it (esven more so if PP) given most of these elective RRA cases are trainwrecks. I dont mind doing rearfoot trauma. I typically got $1000 for a bimal medicare rates at my last job. Trimal was around 1300. I find ankle trauma to be one of the easier traumas there are (except pilon). I certainly struggle sometimes but most of them snap back together pretty easy.

But having RRA opens jobs IMO as I recently stated elsewhere on here.

For sure.

RRA is not really anything special... I almost find it easier than bumbling with EHL lengthening and hammertoes and baby screws for Weils and such.

I think the fact that ankle fx are relatively easy and fast and COMMON is the main reason ortho likes them and protects them. Orthos gen or any specialty can usually crack out fib or bi-mall done well in under an hour. With the exception of pilons and higher energy injuries or medically sketchy patients, ankles are fairly straightforward for anyone who understands AO/ASIF... and HWRs pay good also. We make them out to be some big thing in DPM land, but most are pretty routine fixes as long as syndesmotic instability is not missed.

Pilons are rougher... they just take a real long time to do fairly well and only pay ~30% more even though they take 2-3x longer and more f/u visits. I would go broke doing the ones like this morning's every day or every week. You almost have to hope they have wound issues so you can get some codes on the f/u visits ...no reimbursement mystery that really only F&A ortho, trauma ortho, and some DPMs do them 😳

Calcs are fairly lame too. 🙂

 

[DYK343]

Calcs are fairly lame too. 🙂

Joint depression calcs are the worst. Of all surgeries I do thats probably the one I like the least. I was doing them quite frequently. Glad thats done with. Especially when its bilateral. Those days are bruuuuuutal.

 

[Feli]

Joint depression calcs are the worst. Of all surgeries I do thats probably the one I like the least. I was doing them quite frequently. Glad thats done with. Especially when its bilateral. Those days are bruuuuuutal.

Yeah, I just do my extensile, throw a Bohler tuber pin, have a tech pull traction and a tiny bit of valgus, pin posterior to anterior a couple times, pin k-wires under post facet a few times, small screw or two under post facet into sustentaculum, plate the lateral wall, and get out. It's not hard... Lapidus is far harder and more pt expectations.

If I got calc fx out of varus and got the height/shape fairly regular, that's a win. Especially if it took under 90min with all the sutures. 🙂

Maybe I'm lazy, but I don't really get the "artwork" of trying to make the posterior facet perfect or any of it perfect. It's not going to move well. It will need injects and/or brace and STJ fusion if it was any severe one. Intra-artic calcs are nasty injuries; I just consider the goal to have them fit into shoes and kick the arthritis down the road awhile.

 

[DYK343]

Yeah, I just throw a Bohler tuber pin, have a tech pull traction and a tiny bit of valgus, pin posterior to anterior a couple times, pin k-wires under post facet a few times, small screw or two under post facet into sustentaculum, plate the lateral wall, and get out. It's not hard... Lapidus is far harder and more pt expectations.

If I got calc fx out of varus and got the height/shape fairly regular, that's a win. Especially if it took under 90min with all the sutures. 🙂

Maybe I'm lazy, but I don't really get the "artwork" of trying to make the posterior facet perfect or any of it perfect. It's not going to move well. It will need injects and/or brace and STJ fusion if it was any severe one.

I primary fuse almost all of them now. Its a pain to try to fuse later with all that hardware in there (either snake around it or remove which a 2nd lateral extensile incision wreaks havic on the soft tissue). If im doing sinus tarsi approach I usually dont fuse because the fx usually isnt that bad.

IMO its inevitable they gonna get a fusion later so I just do it at time of ORIF. Significant less loss of work for the patient and return to near normal activities so much quicker.

I have never been paid for ORIF and fusion. Usually I only get paid for fusion.

 

[Feli]

That's cool... I have been considering that for geriatric ankle fx but haven't had a calc fx severe enough to consider it in awhile (I prob should consider it more tho). I do primary AD for a majority of operative Lisfranc.

That's too bad about not getting CPT for ORIF and fusion.... try STJ disloc + fusion, that'd seem legit also? Arthroeresis probably ruined that.

We should invent a total subtalar arthroplasty (TSA). I think that acronym might be taken tho.

 

[DYK343]

That's cool... I have been considering that for geriatric ankle fx but haven't had a calc fx severe enough to consider it in awhile (I prob should consider it more tho). I do primary AD for a majority of operative Lisfranc.

That's too bad about not getting CPT for ORIF and fusion.... try STJ disloc + fusion, that'd seem legit also? Arthroeresis probably ruined that.

We should invent a total subtalar arthroplasty (TSA). I think that acronym might be taken tho.

I was doing 4-5 a month at my last job. It was like drinking from a firehose for the 5ish years I worked there but eventually I burned out and had to leave. I was always on call. Got boards behind me, a nice nest egg built up, and peaced out.

Anyways, yeah I would say I fuse about 70% or more of them primarily. I pin the calc fx where I want it, throw the fusion lag screw(s), and then plate lateral extensile to hold it all in place. Its kinda sketchy throwing the fusion screw because I am always waiting for it to all collapse with compression but as long as you stay medial/close to sustentaculum its not a problem (and dont go crazy with the compression).

 

[deleted285117]

Y’all underestimate the power of the low dye strap.

 

[DYK343]

Y’all underestimate the power of the low dye strap.

Hey at least you get paid to throw one of those on!

 

[AttackNME]

Anyways, yeah I would say I fuse about 70% or more of them primarily.

Which sanders classification calcs you fusing?

 

[DYK343]

Which sanders classification calcs you fusing?

1 and 2 I usually dont fix at all or do sinus tarsi approach. Fuse zero of those.

3 and 4 usually go for fusion unless I am really feeling really good about the reduction (even then I always wish retrospectively I fused it primarily).

Lots of literature out there to fuse vs not fuse. Seems to go back and forth. In my hands primary fusion is the way to go. If I have a 3 or 4 sanders calc fx I would perosnally request fusion (along with restoration of width/height).

- - -

And what I meant in the above post is if I am doing a lateral extensile im primarily fusing along with it about 70% of the time.

 

[air bud]

1 and 2 I usually dont fix at all or do sinus tarsi approach. Fuse zero of those.

3 and 4 usually go for fusion unless I am really feeling really good about the reduction (even then I always wish retrospectively I fused it primarily).

Lots of literature out there to fuse vs not fuse. Seems to go back and forth. In my hands primary fusion is the way to go. If I have a 3 or 4 sanders calc fx I would perosnally request fusion (along with restoration of width/height).

- - -

And what I meant in the above post is if I am doing a lateral extensile im primarily fusing along with it about 70% of the time.

Fused my last one via sinus tarsi. Beauty of fusion is you don't have to get the joint perfect so pairs well with sinus tarsi

 

[DYK343]

Fused my last one via sinus tarsi. Beauty of fusion is you don't have to get the joint perfect so pairs well with sinus tarsi

I dont disagree.

The 3s and 4s though usually have loss of height and lateral wall blowout. I always struggled getting that reduced with sinus tarsi approach. T

he lateral extensile its fairly straight forward but is a much more involved procedure, more pain, and more risk.

Peroneal irritation and anterior ankle impingement really bother patients. Even with a STJ fusion. To prevent that I usually go lateral extensile.

 

[Pronation]

I dont disagree.

The 3s and 4s though usually have loss of height and lateral wall blowout. I always struggled getting that reduced with sinus tarsi approach. T

he lateral extensile its fairly straight forward but is a much more involved procedure, more pain, and more risk.

Peroneal irritation and anterior ankle impingement really bother patients. Even with a STJ fusion. To prevent that I usually go lateral extensile.

Sinus tarsi approach is kinda like MIS bunions - you have to get over the cringeworthy x-rays and remember that the patients have good results (comparatively). I focus less on the facet and more on the width and especially the height so that they don't end up getting anterior ankle impingement.

 

[air bud]

Lol a bunch of pods talking about fixing calc Fx...GTFO
Next you are going to have the eyeball doctors talking about fixing detached retinas....stick to your hammer toes and cataracts.

 

[HardRoadPaved]

I'm waiting on the onychomycosis panel led by an ID expert

 

[wakaflocka88]

Sinus tarsi approach is kinda like MIS bunions - you have to get over the cringeworthy x-rays and remember that the patients have good results (comparatively). I focus less on the facet and more on the width and especially the height so that they don't end up getting anterior ankle impingement.

But ABFAS will fail it it doesnt look pretty. But I’m sure none of the case reviewers have touched a calc in over 30 years

 

[Pronation]

But ABFAS will fail it it doesnt look pretty. But I’m sure none of the case reviewers have touched a calc in over 30 years

I have no doubt about that. This is why I didn’t do any cases that could be scrutinized in this way until I was board cert 2 years out. For those first 2 years I avoided MIS bunions and sinus tarsi calcs for sure.

 

[JewOnThis]

As someone who is double boarded, I have always dislike the process of getting certified by abfas. I failed the rearfoot boards twice and then finally passed on my 3rd attempt. The computerized case review is just plain silly. We should go back to orals.

 

[air bud]

As someone who is double boarded, I have always dislike the process of getting certified by abfas. I failed the rearfoot boards twice and then finally passed on my 3rd attempt. The computerized case review is just plain silly. We should go back to orals.

Welcome back....why don't you mosey on over to the meme thread...and contributions are welcome.

 

[JewOnThis]

Welcome back....why don't you mosey on over to the meme thread...and contributions are welcome.

I needed a break. Looks like one of our main contributors got banned. 😭

 

[air bud]

How can you have a residency be a gatekeeper when you have the PP guys have a direct financial incentive to have warm bodies for them to use to do surgeries for them or round etc? If everyone was salaried and hospital employed....or at least the majority then not that direct conflict of interest.

 

[Bored Snorlax]

@diabeticfootdr

1. Why are new schools being opened instead of focusing on improving the performance of existing schools and allocating them resources?

2. What steps are being taken to increase board performance and standardization of training/competency to promote the field of podiatry in a positive manner?
- MD/DO schools have a 1st time pass rate of 97-98%, but some podiatry schools have a 3yr avg. pass rate of 69-75%. This is an alarming figure and must be addressed immediately. There is a lot of financial risk involved with those statistics.

3. What assurance will new students like me have that there will be adequate and high quality residency slots when I graduate in 3.5 years? You mentioned there is no shortage currently, but situation changes each year.

Looking forward to your response and thank you for your time.

 

[icebreaker32]

When you consider the pass rates, and combine that with the attrition, percent of good residencies and job market.....podiatry is a great profession for 25% (at most), a fair profession for 50% (eventually) and a horrible profession for 25% (forever).

If you want to be a MD, DO, RN or PA/NP you have about 90% or greater chance to pass you licensing exams, land a good a job where you want with benefits and often recruitment and loan repayment repayment incentives for the salary you anticipated.

About the only professions you can really compare podiatry to is chiropractor school and offshore medical schools. I have known many that have done well with offshore medical school that were hard workers and the equivalent of the top 25 percent at best of a typical podiatry class academically......but many offshore schools will take anyone, at about anytime of the year.

 

[Bored Snorlax]

When you consider the pass rates, and combine that with the attrition, percent of good residencies and job market.....podiatry is a great profession for 25% (at most), a fair profession for 50% (eventually) and a horrible profession for 25% (forever).

If you want to be a MD, DO, RN or PA/NP you have about 90% or greater chance to pass you licensing exams, land a good a job where you want with benefits and often recruitment and loan repayment repayment incentives for the salary you anticipated.

About the only professions you can really compare podiatry to is chiropractor school and offshore medical schools. I have known many that have done well with offshore medical school that were hard workers and the equivalent of the top 25 percent at best of a typical podiatry class academically......but many offshore schools will take anyone, at about anytime of the year.

You hit the nail on the head. If students are performing well academically and on the boards it will attract more people to podiatry.
If there is high attrition and low salary it will deter people from the field.
We have schools with 60s and low 70s for APMLE part 1 pass rate and many students will be screwed financially.
If our board pass rates were higher there would not be a surplus of residencies (still skeptical about this) and the overall competency of a graduating podiatric physician would be on par with other medical providers.

But instead they elected to open more schools instead of focusing on improving existing schools.

- how will this improve board exam performance with fresh schools?
- how will this secure more residency position for students?
- how will this create more jobs for the profession?
- how will this increase competency and residency quality?

I would love for the podiatry leadership to share their insight into these problems.

 

[Pronation]

This thread needs to be renamed from Questions for podiatry’s leaders to Questioning podiatry’s leaders

 

[AttackNME]

@Bored Snorlax the schools opening were done independently, no one can stop someone from opening a school, otherwise it’s viewed as anticompetitive. With that said, I agree that standardization of education in pod school and residency is needed. As a student you just have to be patient and suck it up for now, podiatry is an evolving field and as such, school curriculum is trying to evolve too to keep up with what the movers and shakers are doing. Just accept the fact that once you come out to externships, there is going to be a LOT of stuff that they didn’t teach you in school.

Regarding leadership, it’s clear no one’s picking up the phone and talking to each other. If they are, those conversations have obviously not been productive. They can’t come to some agreement, nor are they understanding each others’ problems

 

[Bored Snorlax]

@Bored Snorlax the schools opening were done independently, no one can stop someone from opening a school, otherwise it’s viewed as anticompetitive. With that said, I agree that standardization of education in pod school and residency is needed. As a student you just have to be patient and suck it up for now, podiatry is an evolving field and as such, school curriculum is trying to evolve too to keep up with what the movers and shakers are doing. Just accept the fact that once you come out to externships, there is going to be a LOT of stuff that they didn’t teach you in school.

Regarding leadership, it’s clear no one’s picking up the phone and talking to each other. If they are, those conversations have obviously not been productive. They can’t come to some agreement, nor are they understanding each others’ problems

I completely understand some things are out of people's control.

However, we still have high attrition rate and abysmal board performance which nobody is even addressing. It may not affect most people in this thread, but it will affect my colleagues and I who are still in school.

The surplus @diabeticfootdr brought up would not even be possible if more students pass their boards and graduate on time.

Opening up new schools will not rectify these problems and more people would likely go into financial ruin given the current pass rate and graduation time. How will this attract potential applicants to podiatry given the current status quo?

The podiatry leaders constantly peach about increasing quality of residencies and standards, but how will diluting the profession before increasing standards, producing better outcome, and securing better job opportunities help with any of that?

I would appreciate if someone shares some insights on this because so far none of this makes any logical sense to me.

 

[Weirdy]

I completely understand some things are out of people's control.

However, we still have high attrition rate and abysmal board performance which nobody is even addressing. It may not affect most people in this thread, but it will affect my colleagues and I who are still in school.

The surplus @diabeticfootdr brought up would not even be possible if more students pass their boards and graduate on time.

Opening up new schools will not rectify these problems and more people would likely go into financial ruin given the current pass rate and graduation time. How will this attract potential applicants to podiatry given the current status quo?

The podiatry leaders constantly peach about increasing quality of residencies and standards, but how will diluting the profession before increasing standards, producing better outcome, and securing better job opportunities help with any of that?

I would appreciate if someone shares some insights on this because so far none of this makes any logical sense to me.

You are rehashing things we have repeated over and over again already.
Its reasonable to voice concerns and opinions.

But don't rehash the same problem just to sound eloquent.

Boards pass rates are a responsibility of the schools and students themselves. Superstar students will pass all their boards no matter what school they are at. Could there be curriculum/staffing changes to make it harder so that only superstar students are getting admitted >> higher pass rates? Yes. But that is more in the realm of what the school can do, not the current podiatry leadership.

edit; looking back i did nothing to contribute. Here are ways schools can increase their board pass rates and attrition

1) More rigorous gatekeeping. Increase admission scoring and standards. Stop scraping for bottom of the barrel. As much as I disagree with new schools opening in general, the Texas school, per their own horn tooting, seems to have taken this into consideration and recruited those with high stats. Higher stats = higher chance of passing boards and graduating. Can't speak to their soft skills.

2) Limit seats at each school. Lower quantity and focus on quality. This is impossible for some programs who already have small class sizes as they will cease to exist. The larger programs are more likely to be able to limit seats, but they do so at the risk of their bottom line and operating expenses.

3) Curriculum changes. This feels at times like a double edge sword. If you switch strictly to boards related teaching, they will be stellar in their board pass rates, but their actual experience and critical thinking skills take a hit. As a resident, you use the knowledge you have to think for yourself and the patient. The board answers may have jack all to do with the real world results. Do you want an army of 4th year students who can only recite board answers when in 1 year, they will be taking care of real patients that come with real consequences? You need a balance of both. The MD/DO curriculum/boards/correlation to how well they do in clinic is apples to oranges- they manage more complex pathologies and need to cover a much broader scope in detail. I disagree with your opinion of"If they all pass their boards and do well, how come podiatry is not the same?".

 

[Boba Foot]

I completely understand some things are out of people's control.

However, we still have high attrition rate and abysmal board performance which nobody is even addressing. It may not affect most people in this thread, but it will affect my colleagues and I who are still in school.

The surplus @diabeticfootdr brought up would not even be possible if more students pass their boards and graduate on time.

Opening up new schools will not rectify these problems and more people would likely go into financial ruin given the current pass rate and graduation time. How will this attract potential applicants to podiatry given the current status quo?

The podiatry leaders constantly peach about increasing quality of residencies and standards, but how will diluting the profession before increasing standards, producing better outcome, and securing better job opportunities help with any of that?

I would appreciate if someone shares some insights on this because so far none of this makes any logical sense to me.

In my anecdotal experience from pod school, the people who failed boards 1 and/or 2 were people who shouldn't have been let in to pod school to begin with. There were some exceptions, but true for the majority. Unfortunately, the schools are letting in kids who have a very low chance at success in order to fill seats. Not sure that's exactly podiatry-specific issue though, higher education across the board is guilty of doing this.

 

[Weirdy]

3. What assurance will new students like me have that there will be adequate and high quality residency slots when I graduate in 3.5 years? You mentioned there is no shortage currently, but situation changes each year.

In regards to this question specifically:

You seem to be very worried about the outlook of what your chances are for only being 0.5 years into podiatry school. I can respect that.

If you are worried, there are a few things you should do that will give you more confidence going into the match 3.5 years from now.

1) Get the highest GPA you can. This will open doors in terms of residency programs you can apply to. It does not matter if there is a shortage if you've already beat out 80-90% of those around you with grades alone.

2) Be normal. Be personable. Be teachable. Don't throw people around you under the bus. This is a small field. We remember how you treated those around you during school, clerkships, and even as a resident. Karma is real. Be the best person you can be to those around you.

A few other caveats:

There are sleeper programs that have you coming out very well trained. There are name brand programs that are only well regarded in name alone but not actual experience. Learn to decipher between the two during your clerkships. Your classmates will talk and brag like they know what they are talking about. They do not. Ignore it. Work hard and keep your head down until you get there in person for clerkships. Then decide for yourself.

 

[Adam Smasher]

Opening up new schools will not rectify these problems and more people would likely go into financial ruin given the current pass rate and graduation time. How will this attract potential applicants to podiatry given the current status quo?

I wrote a thread about this where I hypothesized we'll continue to see more schools vying to attract a smaller and smaller applicant pool.

In theory what could happen is the new schools will compete against the old DPM factories (New York, Philly, Chicago, Ohio) by offering a higher quality education at a lower cost. A guy can dream, right?

 

[Weirdy]

In theory what could happen is the new schools will compete against the old DPM factories (New York, Philly, Chicago, Ohio) by offering a higher quality education at a lower cost. A guy can dream, right?

I can see it going the way of pharmacy with lower quality + same cost or higher quality + private only.

I do not have faith in the podiatry community to see it go higher quality + lower cost. That takes too much money and resources to make a profit and stay open.

 

[dtrack22]

Boards pass rates are a responsibility of the schools

Deans at Temple and OCPM (at the time) would disagree with this. That was their argument years ago when being criticized for passing students along (and even graduating them) without having passed either part I or part II of their boards. They claimed that they test was not part of the school curriculum and therefore they could not only move the student up a grade, but even give them a diploma at the end of 4 years. I’m pretty sure the practice was stopped but I don’t know that it was actually implemented as some sort of CPME criteria that schools were forced to follow. Sad.

CPME regulations and accreditation criteria are the only way to indirectly limit seats, but I don’t think anyone cares enough to do that to the schools and their $$$ bottom line.