Forum Members ABFAS/ABPM

[newpodgrad]

Hey guys

While looking for jobs , I inquired with a few local hospitals about how to go about getting privileges.

Several of them sent me info and I wanted to highlight a board concern.

Not sure how to really take it, but here’s a excerpt from one of the docs re: board status.

“Board Certification Requirement means certification from one of the following boards: the American Board of Medical Specialties, the American Osteopathic Association, the American Board of Foot and Ankle Surgery, or those Boards which may be approved by the Executive Committee to satisfy this Requirement”

As a disclaimer, I’m not a HUGE surgery pod. I enjoyed it , and did it in residency because, well, that’s what we had to do. And I’m fine with my forefoot procedures. I believe I’ve done well with them at my current level. I don’t care to do TARS, scopes mid foot fusions etc. I have no problem referring them out. I took the ABFAS qualifying tests etc, because again, it’s encouraged in residency and passed them.

Looking at this doc, it almost seems like this board required if you wanted to be on staff. The little statement at the end regarding “or those boards” seems like it might open the door for ABPM with some petitioning or something.

What do you guys make of this? I have heard from others that ABPM will get involved with issues regarding privileges etc. Is there more to this picture than meets the eye?

Thanks in advance for everyone’s take

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[CutsWithFury]

First off, I’ll work on getting the cert.

Secondly and more importantly, board certification , especially in podiatry, doesn’t dictate who’s a good surgeon and who isn’t. Not all podiatry residencies are the same. Some have thriving numbers and others have residents that retract and log the case as “first assist” and magically graduate into attendings.

Like I mentioned in my original post I was and am fortunate to have actually done cases, so I’m comfortable with my skill set.

Others might not have had the same training but yet are able to get by the boards and some how generate cases. I know people who get jobs with a parent that’s also a podiatrist and somehow these guys get boarded pretty quick. Kinda suspicious , no?

I would base my decisions on who can actually do cases and who does cases routinely. You can have a abfas cert dude that’s “certified” but does 1 case every other month.

Would you be comfortable with a surgeon like that operating on a loved one based on the letters after their name?

Disagree with this thought process completely. Board certification is a standard everyone should strive to get. ABPM cert is just a test. They don't ask for logs. ABFAS sets minimum amount of cases per category you have to meet to sit for the exam.

If you look at the numbers needed to meet ABFAS criteria to sit for the exam the cut offs are LAUGHABLE. If you can't get those numbers then you don't do enough surgery and if you don't enough surgery you can't be or become a good surgeon.

Being a big time surgeon who is only certified by the ABPM doesn't even make sense. How can you even determine someone with only ABPM is a good surgeon? You can't because they have no official case logs you can refer to. ABFAS at least makes you log and you can use this information to show competency and experience.

Just get board certified by ABFAS. It is not a great system but it is the best we have.

 

[DYK343]

Yeah after reading these threads I’m going to have to.

But in all honesty, if one doesn’t, because the time has lapsed, then what? If you’re qualified , have cases etc. You can only do so many retakes.

Worst case scenario , what happens then?

...youre not ABFAS certified.
Dont pass in 10 years you will never be able to sit for exam again.

 

[air bud]

Was this serious?

Yes. If you are 3 year trained and got qaulifed and want to do surgery....get certified. The older dudes who got grandfathered in....gray area and if history sure fine. But if you are young and never got certified in the gold standard (ABFAS) in surgery (albeit not perfect) ....in then don't do surgery. Get abpm if you need to be boarded for insurance purposes.

Getting foot certified is not asking that much.

Edit - When ABPM starts teaching surgery courses and having surgical lectures and other surgical stuff then I am fine accepting that for hospital surgery privileges. See the common word there? Surgery. That said, there is much more to podiatry than just surgery. Not everyone has to do it. But don't ask to do surgery if you don't have the proper surgical training. As far as I know you can get hospital privileges without surgery just to see in inpatients.

 

[air bud]

so to the OP, completely ok and respectable to focus on forefoot surgery. ABFAS has a forefoot surgery certification, so get that. Better question - would you want your mother having forefoot surgery done by somebody with certification? Or are you just trying to rationalize things to make things easier for you and your own personal sitiuation?

 

[air bud]

I understand board cert doesn't make you a good surgeon. But it does establish a baseline of competency. I don't even know the numbers of cases needed now, but it's low. So do your forefoot cases, do a good job, do the paperwork and get board certified. It's not that much money, it's good for you, it's good for the profession. Willing to die on this hill.

And nobody is sneaking through board certification. They did the cases and submitted them.

 

[air bud]

No one is saying people are sneaking by. But it’s definitely advantageous to have cases given to you to meet the number requirements.

Also, starting off solo from scratch ? Where are you even getting patients from, let alone cases??

Puts a lot of pressure on new grads to find a job that not only will pay bills but will also provide patients that can generate into cases..which now have to fall under the “diversity” requirements of abfas aka not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

7 years. I think you can find enough cases in 7 years. 5 years out and not certified? Whatever you still have time. But 7 years. If you don't have enough cases in 7 years even solo, new etc...then that is a you problem. If you have a pulse, know how to talk to patients and are trained well enough to recognize pathology that requires surgery...then you can get cases. If you are trying to set up shop in an over populated area because your family is from there, your wife works nearby, you like the schools...again that is a you problem.

Okay, I misinterpreted that I thought you were saying people were having other people do cases for them and they were just putting their name on it


And what new grad thinks kalish, ludloff and mau osteotomies are a thing??

 

[Pronation]

not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

Fail.

 

[Feli]

My question is why Dr. Rogers hasn’t taken and passed the ABFAS exam. Does he have an issue with the board? Does he have a problem with the exam? Why exactly wouldn’t he simply be certified by the ABPM and ABFAS?

I’m sure there is no self serving gratification to try to stick it to the ABFAS...

Narrative: too busy doing bigtime Charcot, wound flaps, publishing, etc... didn't get enough bunions for diversity (due to bigtime recons), ran out of years to pass it.

Real story: probably failed the written.

...it's a moot point, though. ABPM will have its place.

I feel pretty sorry for people having surgery from non qual/cert DPMs, but I'm getting good at revisions, lol.
Last week, I was sending one guy with a bit of pain after Brostrom back to his orig surgeon (good published and ABFAS cert DPM near me in a competing group). I usually give them the FootHealthFacts or ABFAS find-a-doc search link printout, and he asked me, "what do you mean when you say 'he's board certified'? You say that like it's a good thing, but isn't that like a minimal requirement for any doctor?"

Me: "Well, uh, if it were up to me, it would be."

 

[newfeet]

The APMA has now spoke on the matter…​

A Statement from APMA on the Announcement of a Certificate of Added Qualification in Podiatric Surgery by the American Board of Podiatric Medicine​ APMA's mission is to defend our members' ability to practice to the full extent of their education and training to best serve the public health. In fulfilling that mission, APMA depends on board certification through the two CPME-recognized boards, the American Board of Foot and Ankle Surgery (ABFAS) and the American Board of Podiatric Medicine (ABPM). The rigorous board certification processes established by these two organizations support APMA's work to demonstrate our members' education, training, experience, and ongoing commitment to quality care. APMA has concerns about the announcement by ABPM of a new Certificate of Added Qualification (CAQ) in Podiatric Surgery: We have heard from members in support of and in opposition to this new CAQ. There are strong feelings on both sides, creating division and discord within a small profession that depends on unity and collaboration to accomplish its goals. The profession has long recognized that there are two distinct specialties in which to be board certified: medicine and surgery. Our single, standardized Podiatric Medicine and Surgery Residency provides access to either or both certifying boards, depending on the choice and practice activity of the individual physician. Our current president, Laura J. Pickard, DPM, is among those physicians who hold certification from both boards. In 2019, APMA convened a Blue-Ribbon Panel to examine specialty board recognition. One outcome of that process, in which both ABFAS and ABPM participated, was a recommendation that APMA reaffirm its longstanding policy of recognizing only one certifying board for each unique area of clinical practice. Recognizing only one board in each area was deemed critical to serving the public interest and mitigating confusion in the health-care community. A CAQ in Podiatric Surgery offered by ABPM would seem to be a duplication of what is already offered by the recognized board for certification in surgery. APMA believes there is a strong possibility that a CAQ in Podiatric Surgery could confuse and mislead the public. A physician who has just completed residency is eligible to earn this CAQ. For those more than three years out of residency, ABPM requires only 25 total cases (five cases from each of five categories) with no requirement for diversity within those categories. Compare these scenarios to ABFAS certification in foot surgery, which requires at least 65 cases. The CAQ in Podiatric Surgery has a high potential to mislead a patient to believe a surgeon has more experience and expertise than they do. The CAQ also causes greater confusion for other health-care specialties, insurance companies, state legislators, and hospitals, which already frequently mischaracterize podiatrists' education, training, and certification. In light of these concerns, APMA consulted with the Council on Podiatric Medical Education. While ABPM notes that CAQs are not recognized by CPME, CPME does have oversight of the boards through its Specialty Board Recognition Committee (SBRC). CPME issued a statement on August 11 requesting that specialty boards "refrain from implementing CAQs, including the CAQ in podiatric surgery," until CPME has an opportunity to complete the planned rewrite of its SBRC documents. APMA supports CPME's statement and its request for delayed implementation. APMA also has reached out to ABFAS and ABPM in an effort to mediate the current situation and broker an outcome that is most beneficial for our members and their patients.

 

[Boba Foot]

Does an orthopedic surgeon who doesn’t do more than a few calc fractures over 7 years still have calc fracture privileges? The answer is yes. Do they do them if they are doing a low volume? The answer is generally no, someone else in the group does. If they started getting more volume 15 years out of practice and wanted to do calcs should they be able to do them? Sure.

How did any podiatrist do ankle surgery before ABFAS RRA designation existed? How can we possibly function without it?

This is simple. There is one board. Let’s call it the American Board of Podiatric Medicine and Surgery. You take a didactic exam (we’ll keep the CPBS stuff to make ABFAS feel good) and then you have a case review, 12 cases TOTAL (like ortho). No diversity requirement. Basically everyone does this their second year out of residency. If you land a job where you don’t have some minimal surgical volume of any kind then you have to wait for the case review part until you do and you only have 5 years instead of 7. If you don’t have really any surgical volume after 5 years or don’t pass the oral case review then you get some random board cert and practice office based podiatry forever. After 5 years something like 90-95% of podiatrists (easily) are certified by the American Board of Podiatric Medicine and Surgery. The local hospitals and ASCs throughout your career will then dictate what you can do based on your training or your practice experience (if you change jobs). Someone who doesn’t do enough ankle fractures or fusions or TARs to make ABFAS happy can still lengthen an Achilles or do a brostrom or perform a flatfoot reconstruction (all of which contain procedures that are a part of ABFAS RRA cert). But what if you change jobs and start seeing some ankle trauma and you want to do it? Well, just like every single old podiatrist who was never trained to do them and somehow started doing them in their career before ABFAS RRA was a thing, you take some continuing education courses, your hospital will require you to have a certain number proctored by a doctor with those privileges, and now you can do ankle fractures. The profession as a whole advocates for all podiatrists as foot and ankle specialists/surgeons. Individuals will almost universally self select practice environments and surgical scope based on training and post-residency experience and then the place where they are performing surgery is the gate keeper. The individual podiatrist is already a gate keeper as a vast majority of people aren’t trying to perform surgeries they don’t see for 7 years after getting out of residency or surgeries that they were never trained to do. The ABFAS is not necessary in this process at all and the fact that they have so many people, like attacknme who think that they are tells me that the ABFAS marketing people need raises.

Weird, that all sounds a lot like the ortho board cert and subsequent practice scope and privileging process huh?

Just in case I lost someone there, if dtrack was made king of podiatry:

-One board to get hospital/OR privileges called the American Board of Podiatric Medicine and Surgery

-part I didactic and part II case review consisting of 12 cases without a diversity requirement at all

-most everyone is board certified to be a podiatrist who operates on patients in 2-3 years. You only get 5 years to complete. There is still random boards to certify people who will do office work forever (because they still need board cert to get on many insurance panels).

-local hospital determines privileges based on training/experience and most places start off with a fairly broad number of privileges as part of the core podiatry privileges, most places are still going to require case logs and proof of competency for stuff ortho wants like ankle fractures and TAR (they don’t give a crap about anything else we do). That’s fine.

-once you are board certified you can still get privileges for surgery you don’t have experience with by doing continuing education and having cases proctored. Just like all the old, big name podiatrists who had subpar residency, practiced before ABFAS RRA was a thing, but now regularly do TARs.

-nothing compromises “patient safety,” Atlanta VA trained podiatrists are still not allowed to fuse ankles, the profession as a whole supports the advancement or protection of our scope instead of trying to limit it like we do now, and all of this is accomplished without ABFAS even existing. You’re welcome Podiatry.

Agreed, but I think a board cert didactic exam is unnecessary. At the point of residency graduation, we’ve taken 3 didactic boards… why do we need another? Make 2 or 3 tougher and then just make board cert a case review as you outlined. Didactic exams tell nothing about the quality and capability of a surgeon anyway, case review does.

 

[SouthOrBust]

Can you tell us how you have chosen to gatekeep your fellow podiatrist?

Cases and education.

Hospitals have a process called PPR (“proctored peer review”):

If you have cases and education you get the privileges.

If you go back and get more education but don’t have the cases yet, they (the privileging board) will find a peer who does have the privileges in the system to supervise/review your work to ensure it is to a safe standard.

If you don’t have the education or cases, you don’t get the privileges.

 

[Pronation]

Not pushing any narrative, fellowship is dumb. But not a lot of programs do TAR or SMO. Certainly not enough to make board training exams focus so heavily on it. Never even saw one being done when I was a student on rotations.

Sorry to hear about your subpar externship rotations. I saw TARs at most of the places I rotated at, did them in residency, and do them in practice. Executing a proper lapidus with a 2nd crossover toe with plantar plate pathology is more technically challenging anyway. This is why I think separating pods who just do “forefoot surgery” is a joke.

 

[Pronation]

As as a student never seen one. As a resident foot and ankle orthos would do like 2 SMO per year and 5 TAR per year. Podiatrist did zero. Maybe a handful of programs offer that. I have friends all over who went to any different programs and none of them were doing enough quality TAR to be able to do that after residency. Not sure if you learn in fellowship, or just take course and help other doc who does it regularly and learn that way.

With all due respect, it seems based on your posts that you went to a mediocre residency program. Like generally hangs out with like, and most of us were sufficiently exposed to TARs in my circle of degenerates.

But also here we are begging and clawing at hospital employed positions where pus is the main focus so that we can be paid like doctors.

 

[Pronation]

Some of us have no interest in doing TARs, bruh.

I wasn’t implying that. I’m just saying that those of us that went to high quality residency programs were exposed to it sufficiently to do them. I have friends that have the training to do them but choose not to (reimbursement vs stress compared to simple/other procedures)

 

[dtrack22]

At least majority of people I encountered, including myself wanted to stay local. And taking to account 600 students, there are not so many of these "top programs" and many of them are in the middle of nowhere. I know, because I visited friends in PA and in NY, and I do not think 3 years there would be amazing. But it is personal preference.

Imagine an MD/DO student saying any of this. “Yeah I matched Derm but decided to do family medicine because I didn’t want to leave NYC.”

If you are talking about living somewhere permanently, I get it. Job search geography limitations make sense. I had them. But for temporary education and training?

But let's be honest, if. you want to find a job in a specific area, you better do residency in that area.

This is objectively false. If you want to get a job in a certain area you should still get the best training you can and then you should have some ties to the area and then you need to get lucky that there is an opening the same year you finish residency. Location of training is meaningless outside of some inbred residency programs and Kaiser.

 

[heybrother]

I don't disagree with you on most of what you said. I haven't reported anybody and I don't intend to start. But literally the first email I received from ABFAS contained 2 attachments and this was the first thing one of them said. Everyone gets the email and everyone still puts BQ over everything. Hell, people list it 10 years out when they are expired.

Its on the website too.

 

[dtrack22]

staying at a job

This is a requirement for ortho. If podiatry had a 6 month logging window, no diversity requirement and an oral case review with the same documentation standards as ortho (no f***ing facility audits or circulator notes for example) I probably would have stayed at my first job for more than 8 months.

If you think about it, a board certification process that essentially mirrors ortho would even be beneficial to PP owners. And Podiatric foot and ankle “surgeons” as well as limb salvage folks could all still be boarded by the American Board of Podiatric Medicine and Surgery

 

[dtrack22]

I thought they could still request deleted cases when they do the facility audit? And if there are 'missing' cases then you're screwed?

The facility audit is one random month that happens to be a similar month/time for most folks.

ABFAS claims they will pull newer cases and that you can discuss hardship with charts from previous jobs directly with them after cases are selected. They claim to be flexible. In the case of someone who has 5,6,7…11 years of logs, there is no way that deleting a group of cases or a whole facility from years ago will (or even can) get audited. If you delete cases from august the year that you register for the case review, then sure, good chance the audit winds up being that month. Then you fail. I would never actually suggest people delete cases…or would I?

 

[Feli]

I guess it depends on your goals. Are you trying to get on staff or get OR privileges?
ABPM qual/cert is a recognized board and should get DPMs on staff (consults/office or wound center)... it will not get you any F&A surgical privileges at most competitive places.

Here is one I got from a NMexico hospital today:
"...Second, you requested privileges for rearfoot procedures. It was noted that your board certification in RRA (reconstructive rearfoot/ankle) surgery expired in August 2019. How do you wish to support that request?

Our office and the Credentials Committee look forward to your reply.

Sincerely,..."

(I am probably one of only 4 or 5 DPMs who are RRA qual/cert and doing those cases in the metro out of dozens who are practicing... told the hospital I re-qualified in RRA and had not sent it in, I do those cases, training logs, practice logs, blah blah)

...the bottom line is that every place makes its own rules. Some are very lax and others are tough. The point is that It is always better to get as many certs as you can give them no reason to reject you.

You could get ABPM involved if you just want to be on staff there. If you want to bring surgery there without ABFAS qual/cert, you are unlikely to achieve that. ABFAS qual and cert are meant to be treated equally for privileging... just apply and send them your board qual letters and maybe the ACFAS and ABFAS privileging docs if you have ABFAS Foot (or Foot + RRA) qual. I have never seen a facility where you can't get OR with ABFAS qual (although many make you get cert within 5-7yrs to keep privi).

 

[newpodgrad]

So the hospital is definitely is a more rural area. Only maybe 10 pods in the whole city. I wonder if that makes a difference when there’s a need

 

[PeaJay]

If there are 10 pods, that is not rural… I work rural and they still want ABFAS. Although they would probably take ABPM after being notified of legal ramifications. I wouldn’t be keen on making that change though as rural communities are tight knit and you do not want to be causing a commotion day 1.

 

[heybrother]

Rural means different things to different people. The real question probably is - are you underserved. 5-10 minutes in any direction from my town is straight agriculture and to a New Yorker I'd be on the edge of the earth - but we're not underserved. We have fewer podiatrists than you, but a Costco and at one point 4 foot and ankle orthos. To an east coaster Des Moines is god forsaken boonies rural agriculture but its a city. A friend of mine practices in an area where the next podiatrist is 30 miles away and he has to refer all vascular cases 2.5 hours up the road. Another poster here I believe has to refer people like 6 hours away if they have something that can't be managed.

 

[dtrack22]

Rural means you either dont have a hospital in town or the one you have is critical access. No “rural” community can sustain more than 2 podiatrists, let alone 10.

That being said my rural hospital only required ABPM. I’m still not ABFAS cert though now that I have enough cases for them to pull only from my current job, I’ll submit next Dec.

 

[PeaJay]

Rural means different things to different people.

I agree. It can mean different things, however that does not make it wrong. You need an patient population of several hundred thousand to sustain 10 pods. That is far from rural.

Living in a megalopolis may warp perspectives, but doesn’t change the definition. I live in a rich area and that in no way makes a middle class neighborhood poor.

 

[heybrother]

I agree. It can mean different things, however that does not make it wrong. You need an patient population of several hundred thousand to sustain 10 pods. That is far from rural.

Living in a megalopolis may warp perspectives, but doesn’t change the definition. I live in a rich area and that in no way makes a middle class neighborhood poor.

No disagreement. I'm more so simply commenting on people who are outside the situation not really understanding it. Like a pre-pod looking at a map and saying - well I'll just move to Omaha because its rural and they'll need me. 100% agree - 10 podiatrists is a bunch.

 

[DYK343]

Here we go again....

Get ABFAS. Its less headache throughout your long career.

 

[Shadowfax12]

how many pods in the country have rearfoot and forefoot abfas

 

[newpodgrad]

Yeah after reading these threads I’m going to have to.

But in all honesty, if one doesn’t, because the time has lapsed, then what? If you’re qualified , have cases etc. You can only do so many retakes.

Worst case scenario , what happens then?

 

[Feli]

Yeah after reading these threads I’m going to have to.

But in all honesty, if one doesn’t, because the time has lapsed, then what? If you’re qualified , have cases etc. You can only do so many retakes.

Worst case scenario , what happens then?

I thought you were a resident from your name/posts...

You get 7 years on ABFAS board qual if you graduated 2014 and after. Before that, grads could qualify for another 7yrs (but you'd still lose surgical privileges at some places if their bylaws said you have to be board cert within 5 or 7 or whatever years). In exchange, unless they got board cert pretty quick, those pre-2014 grads (and a few after them) also get the joys of re-taking CBPS they've already passed, and their in-training exams didn't count for anything... as it now counts for part of the board qual. Every group has their struggles, lol.

If your qualification is expired very recently, I'd talk to ABFAS and see what they say. If you are still qualified, keep working on cases. If you (or anyone) has enough cases, sit for cert CBPS and cases at least a year early so you have a re-take available. I'm sure they have a ton of BQ people who don't quite have enough cases, failed the cert exam, or failed the cert cases... yet they still want to get certified. Call them up. You don't know until you try.

https://www.abfas.org/docs/default-source/abfas-documents/bcdoc.pdf?sfvrsn=bd0d35f1_40

I have a feeling they will change the requirements (longer qual window to get cert, less cases/diversity, etc). They obviously model a lot off AAOS boards (5yr limit of board qual). I believe ABS general surgeons just do a written board qual and then oral board cert (can't exactly try to judge their cases without xrays... what are they going to do, video tape knots and dissections?).

how many pods in the country have rearfoot and forefoot abfas

I don't think they publish this. It is tough to say, especially since it was just Foot and Ankle until 30 years ago. I don't know when the Foot vs RRA cert thing started; I'm sure that's easy to find out but I didn't see it. It is really tough to get apples-to-apples comparison when our residencies and boards seem to change every decade or less. Nobody obviously remembers what a PSR-12 or a RPR was, but they were a thing at one time.

ACFAS website says they have over 7500 members... but they have many who aren't ABFAS cert (students, residents, ABFAS qualified, international, retired, grandfathered in, etc). Also, obviously not everyone who is ABFAS cert joins ACFAS.

I believe ABFAS said they have about that many people certified also since they formed also (can't find it)... but many are still grandfathered in 'Foot and Ankle Surgery' pre-1991 model, so they wouldn't hold RRA since it was a different model. Some are obviously deceased, retired, etc.

We do know there are something like 18k podiatrists in USA with ~15k practicing...
It's hard to say... I'd guess roughly two thirds of the DPMs do or did get ABFAS qual (10k) fresh out of residency, half of all DPMs (2/3 who got qual) probably go on to pass ABFAS Foot cert (~7k), and maybe a third of that 7k get get RRA also (2.5-3k?). Don't take it as gospel, but I would imagine I'm in the neighborhood... 2-3k of DPMs, so only roughly 10-20% of those practicing are RRA cert (and probably at least that many RRA qual with potential to get to RRA cert also) and maybe about half of DPMs are ABFAS Foot cert or otherwise grandfathered by doing whatever the reqs were in their day.

It would be something like this: 18k-20k USA pods > 15k practicing > 7.5k ABFAS Foot or F&A > 2.5k RRA ABFAS

If anyone who works with APMA or one of the board has real stats, that'd be good, but I don't think they are readily available.

 

[newpodgrad]

10? I though 7???

 

[DYK343]

10? I though 7???

Yeah I think I was wrong.

 

[Shiyuan]

ABLES / ABMSP will always welcome you with open arms...

 

[newpodgrad]

ABLES / ABMSP will always welcome you with open arms...

Lol jokes apart

What does one do in that situation

 

[icebreaker32]

Lol jokes apart

What does one do in that situati

If one can not become board certified by ABFAS then they should become board certified by ABPM. If one can not become board certified at all then being board certified by ABMSP or ABLES is an option that may or may not be of any help for getting privileges and on insurance panels etc compared to no boards at all. For many at that point it becomes mainly a marketing thing.

I highly advise that everyone becomes board certified by ABFAS, but I do know of some even fairly young, doing well that could never pass the exam. Many in this situation are even on staff at respected hospitals.

If bylaws change you pray you are grandfathered in and hope insurance plans that you are on don’t kick you off. In reality these things rarely happen, but they could. Some parts of the country are stricter than others.

Also getting and keeping you first job may depend on board certification.

You are not fooling most with these alternative boards. In certain situations it may help with privileges and insurance plans. You might fool some as even ABFAS and ABPM are not part of ABMS like most MD specialties. Most people still don’t fully understand our profession. Having two accepted boards for such a small profession neither part of ABMS and also having the other boards does make it confusing. Those outside of our profession and credentialing rarely know anything at all. For most it is probably a marketing thing to get these alternative boards,

 

[newpodgrad]

So this one leaves it a bit vague . What do y’all think?

Requirements for Podiatric surgeons for surgical privileges include: graduation from an accredited podiatry college and achievement of specialty board certification, or admissibility to sit for certification exam, or successful completion of a minimum of two years podiatric surgical residency (PSR-24) program approved by the Council of Podiatric Medical Education

 

[icebreaker32]

So this one leaves it a bit vague . What do y’all think?

Requirements for Podiatric surgeons for surgical privileges include: graduation from an accredited podiatry college and achievement of specialty board certification, or admissibility to sit for certification exam, or successful completion of a minimum of two years podiatric surgical residency (PSR-24) program approved by the Council of Podiatric Medical Education

Sounds to me board certified by ABFAS and possibly ABPM is good enough…..maybe you could try with other boards, but doubt it.

Sound like being board qualified is good enough.

Sounds like regardless of all the above completion of a 2 year surgical residency or any of the newer 3 year surgical residences is all you need and you don’t even need to be board certified or qualified If you completed the right residency.

If questions you can ask the credentialing committee.

2 year surgical residencies were once uncommon at one point, but there were still paths to board certification with a one year residency. Probably just a preceptorship and cases were required at one point, but those podiatrists are aging out. These bylaws seem like they were made over 15 years ago, but still seem fair to me. They need to update the residency lingo and should probably be more specific on boards.

That is what I am telling you it really depends on your area and if someone else (often a podiatrist) is trying to screw you.

I know of podiatrists not board certified that could not pass boards, but well trained and are on staff at the best local hospitals and surgery centers. I know of others in the same situation that can not get on staff at any legit hospital in their area.

 

[JewOnThis]

If you can’t get boarded by abfas in 3 of years of practice then you probably won’t get boarded by abfas.

 

[air bud]

Sounds to me board certified by ABFAS and possibly ABPM is good enough…..maybe you could try with other boards, but doubt it.

Sound like being board qualified is good enough.

Sounds like regardless of all the above completion of a 2 year surgical residency or any of the newer 3 year surgical residences is all you need and you don’t even need to be board certified or qualified If you completed the right residency.

If questions you can ask the credentialing committee.

2 year surgical residencies were once uncommon at one point, but there were still paths to board certification with a one year residency. Probably just a preceptorship and cases were required at one point, but those podiatrists are aging out. These bylaws seem like they were made over 15 years ago, but still seem fair to me. They need to update the residency lingo and should probably be more specific on boards.

That is what I am telling you it really depends on your area and if someone else (often a podiatrist) is trying to screw you.

I know of podiatrists not board certified that could not pass boards, but well trained and are on staff at the best local hospitals and surgery centers. I know of others in the same situation that can not get on staff at any legit hospital in their area.

As a board certified podiatrist (foot/rra) you bet your ass I am doing what I have to in order to keep a non certified pod 7 plus years out (qualified didn't get certified) from doing surgery at a hospital I go to.

 

[GreenHousePub]

As a board certified podiatrist (foot/rra) you bet your ass I am doing what I have to in order to keep a non certified pod 7 plus years out (qualified didn't get certified) from doing surgery at a hospital I go to.

Was this serious?

 

[Scrantonicity]

Was this serious?

Yeah, just don't let Dr Nobody know.

 

[CutsWithFury]

What’s even more vague is that some get foot certified and never RRA because they couldn’t. Then they go to the hospital and say they are certified and then they are allowed to do ankle work. I’ve seen that.

 

[newpodgrad]

First off, I’ll work on getting the cert.

Secondly and more importantly, board certification , especially in podiatry, doesn’t dictate who’s a good surgeon and who isn’t. Not all podiatry residencies are the same. Some have thriving numbers and others have residents that retract and log the case as “first assist” and magically graduate into attendings.

Like I mentioned in my original post I was and am fortunate to have actually done cases, so I’m comfortable with my skill set.

Others might not have had the same training but yet are able to get by the boards and some how generate cases. I know people who get jobs with a parent that’s also a podiatrist and somehow these guys get boarded pretty quick. Kinda suspicious , no?

I would base my decisions on who can actually do cases and who does cases routinely. You can have a abfas cert dude that’s “certified” but does 1 case every other month.

Would you be comfortable with a surgeon like that operating on a loved one based on the letters after their name?

 

[Feli]

so to the OP, completely ok and respectable to focus on forefoot surgery. ABFAS has a forefoot surgery certification, so get that. Better question - would you want your mother having forefoot surgery done by somebody with certification? Or are you just trying to rationalize things to make things easier for you and your own personal situation?

Waydumminit. What if my mom's surgeon just has naturally good hands... played a lot of video games and did a lot of sewing and stuff?

Maybe they don't have time to take boards. Just because MDs have boards doesn't mean DPMs should. We're different. Maybe they are awesome surgeons yet too busy to study or too busy to keep track of their cases and learn from that process. What about DPMs that have a YouTube or a TV reality show, so we already know they're highest quality?

People like that don't need to actually pass tests on surgery indications or produce xrays that they can reduce IM angles, choose appropriate fixation, reduce fractures, or achieve fusions. They should just be allowed to fix cavus and TARs and whatever they say they can fix wherever they want. I would trust them operating on my family twice on Sundays.... but I guess ORs aren't doing cases that day.

...Getting foot certified is not asking that much...

No, definitely not. 65 (?) foot cases over the ~5yrs out of residency is only about one procedure per month (and then even a couple re-takes if needed). Sometimes the procedures come many in a single case, so it is not impossible by any stretch. It helps not to job-hop, but it can definitely be done by the vast majority of DPMs.

 

[newpodgrad]

I understand board cert doesn't make you a good surgeon. But it does establish a baseline of competency. I don't even know the numbers of cases needed now, but it's low. So do your forefoot cases, do a good job, do the paperwork and get board certified. It's not that much money, it's good for you, it's good for the profession. Willing to die on this hill.

And nobody is sneaking through board certification. They did the cases and submitted them.

No one is saying people are sneaking by. But it’s definitely advantageous to have cases given to you to meet the number requirements.

Also, starting off solo from scratch ? Where are you even getting patients from, let alone cases??

Puts a lot of pressure on new grads to find a job that not only will pay bills but will also provide patients that can generate into cases..which now have to fall under the “diversity” requirements of abfas aka not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

 

[Feli]

...now have to fall under the “diversity” requirements of abfas aka not too many Austin’s but we need some z osteotomies, Kalish ludloff mau etc

Your other thread says you are a graduating resident, so you have plenty of time if you're now ABFAS qual. It is a reasonable process. I do basically nothing first ray but Lapidus, Austin, MPJ1 fusions, cheilectomy, amps for that category... I met diversity. You can log a first met head resect for osteo as amp or mgmt bone/joint infection first ray. An Austin with a bit of bone spurs can be joint salvage osteotomy. It is not very hard at all. You don't need MPJ implants (100% stupid) or midshaft/base osteotomies (99% stupid these days with how fast Lapidus can walk and heal and the long term IM correction/revision research ). Diversity reqs below are very reasonable; that's not an excuse.

-ABFAS volume/diversity is a bit harder if you go solo and start with nothing, but you will get enough for Foot - perhaps RRA - in 7yrs (but try to sit after 5 or 6yrs so you have safety nets available). Remember that, just like PPR resident logs, a patient undergoing bunion, 2 weil, 3 hammertoes is 6 procedures towards your 65 for Foot reqs... not one.
-It gets a little tricky if you job-hop (I would suggest screen-shot your XRs and notes if you know you'll be leaving a job instead of counting on them to help you years later when you sit ABFAS... I did both methods and former is a ton easier, past jobs have ZERO reason to help you and basically consider it a HIPAA risk and time waste to send you records and XRs).
-I will fully admit I screwed up getting ABFAS in a timely manner due to job-hopping (job I did the most surgery at in my first 3-4yrs out of training didn't even have digital XR... no prayer of ever tracking those down!). If I could go back, I might have just ridden out my first job or some hospital job to get the cases and get it done; which is what many of my classmates who got their ABFAS done sooner did (stayed until board cert, even if they didn't like the job).
-RRA ABFAS case numbers/diversity are quite a bit harder to get than ABFAS Foot in typical podiatry PP or solo, but it is possible and depends on area referral patterns and how your practice markets... also depend if other in your PP group will feed you RRA or whether they do it themselves. That RRA volume's significantly easier to find and do in most hospital/MSG/ortho setups, though. I know some who have achieved the ABFAS volume in a year or two for both Foot and RRA (but had to wait until 2nd year out to apply when they have enough surplus of cases and follow-up).

"

PLS Logging Requirements​

Foot Surgery Certification​

• Must log a minimum of 65 cases in Podiatry Logging Service (PLS) for eligibility.
• Must include a minimum of 30 cases, from the First Ray, Other Osseous, and Reconstructive Rearfoot/Ankle categories listed in Appendix A (see below)...

...Each category in “italics” has an allowable maximum of 2 of the 30 required cases.
Each category in “non-italics” has an allowable maximum of 15 of the 30 required cases.

Hallux Valgus Surgery

2.1.3 bunionectomy with phalangeal osteotomy
2.1.4 bunionectomy with distal first metatarsal osteotomy
2.1.5 bunionectomy with first metatarsal base or shaft osteotomy
2.1.6 bunionectomy with first metatarsocuneiform fusion
2.1.7 MTPJ fusion
2.1.8 MTPJ implant
2.1.10 bunionectomy with double correction with osteotomy and/or arthrodesis

Hallux Limitus Surgery

2.2.1 cheilectomy
2.2.2 joint salvage with phalangeal osteotomy (Kessel- Bonney, enclavement)
2.2.3 joint salvage with distal metatarsal osteotomy
2.2.4 joint salvage with first metatarsal shaft or base osteotomy
2.2.5 joint salvage with first metatarsocuneiform fusion
2.2.6 MTPJ fusion
2.2.7 MTPJ implant

Other First Ray Surgery

2.3.2 osteotomy (e.g., dorsiflexory)
2.3.3 metatarsocuneiform fusion (other than for hallux valgus or hallux limitus)
2.3.4 amputation
2.3.5 management of osseous tumor/neoplasm (with or without bone graft)
2.3.6 management of bone/joint infection (with or without bone graft)
2.3.7 open management of fracture or MTPJ dislocation with fixation
2.3.8 corticotomy with callus distraction"

 

[DYK343]

Like I said above. Its really not that hard and just get ABFAS. It will make your long career much easier.

 

[GreenHousePub]

Yes. If you are 3 year trained and got qaulifed and want to do surgery....get certified. The older dudes who got grandfathered in....gray area and if history sure fine. But if you are young and never got certified in the gold standard (ABFAS) in surgery (albeit not perfect) ....in then don't do surgery. Get abpm if you need to be boarded for insurance purposes.

Getting foot certified is not asking that much.

Edit - When ABPM starts teaching surgery courses and having surgical lectures and other surgical stuff then I am fine accepting that for hospital surgery privileges. See the common word there? Surgery. That said, there is much more to podiatry than just surgery. Not everyone has to do it. But don't ask to do surgery if you don't have the proper surgical training. As far as I know you can get hospital privileges without surgery just to see in inpatients.

Literally becoming a stereotype. "The only people who will want to restrict your privileges at a hospital will be other podiatrists"

 

[Feli]

Literally becoming a stereotype. "The only people who will want to restrict your privileges at a hospital will be other podiatrists"

This is the way it is for every profession... health care or otherwise. The professions largely regulate themselves.

The state nursing licensing in each state and their national board exams are by RNs (with a few consultants). The hospital director of nursing is RN, charge nurses who interview and approve hires are RNs, etc. Electrical contractors... attorneys... realtors... architects... the list is endless. They all self-regulate with some additional oversight or community members on the state boards also. Podiatry, like all the rest, does the same: "a jury of your peers."

It is natural for hospitals to get their guidelines for credentialing and privileging general surgeons from general surgeons, hospitalists from hospitalists, DPMs from DPMs, orthos from orthos. At bare minimum, the current med staff of same specialty as the applicant are consulted for any help on the applications or appropriate scope. Sometimes, if they don't have that same type of doc, they use the closest thing (gen surgeon to credential a vasc surgeon, internal med to credential a rheum or ICU doc, etc).

What would you propose as an alternative? Nobody says the current standards are perfect, but I sure don't have a better solution than to have basic competency board exams and largely parallel ortho and gen surg boards and privileging norms. Likewise, we almost invariably see any hospital CMO or chief of surg to consult with a chief of pod or reliable staff DPMs when updating bylaws or when new DPMs apply.

It would be pretty weird if cardiologist privileges were limited by ENTs or OBs or OMFS... if the new neurosurgeon was judged by ER and podiatry docs or the CRNAs. It would be even worse - and highly dangerous - if every doc just got whatever privileges they signed up for with no oversight at all (yet that's exactly what you see as some ASCs, small for-profit hospitals, and some govt hospitals... some docs/surgeons do basically whatever until serial malpractice or gross negligence eventually shuts them, or even the whole facility, down).

Is there a potential for misuse of professions regulating themselves? Of course. There is often a "stealing meat from my land" bias between the existing medical staff of that specialty and the new applicant (especially when they are a competing doc/group). That mistrust of new peers is inevitable for plastics, pods, onco surg, or anything else from mechanics to airline pilots. Boards and certifications and case logs actually quell that bias by providing objective competence and common ground in most cases. A group of DPMs in whatever city I go to next could hate me and not want my competition all they want... but they will also see I've passed same/more boards they have and my logs are solid. The objective standards and national exams make any whole specialty better in that locality, state, etc by having measured standards. It is up to each of us if we view it as a bad thing or a necessary standard that exists in all professional trades.

 

[newfeet]

Hey guys

While looking for jobs , I inquired with a few local hospitals about how to go about getting privileges.

Several of them sent me info and I wanted to highlight a board concern.

Not sure how to really take it, but here’s a excerpt from one of the docs re: board status.

“Board Certification Requirement means certification from one of the following boards: the American Board of Medical Specialties, the American Osteopathic Association, the American Board of Foot and Ankle Surgery, or those Boards which may be approved by the Executive Committee to satisfy this Requirement”

As a disclaimer, I’m not a HUGE surgery pod. I enjoyed it , and did it in residency because, well, that’s what we had to do. And I’m fine with my forefoot procedures. I believe I’ve done well with them at my current level. I don’t care to do TARS, scopes mid foot fusions etc. I have no problem referring them out. I took the ABFAS qualifying tests etc, because again, it’s encouraged in residency and passed them.

Looking at this doc, it almost seems like this board required if you wanted to be on staff. The little statement at the end regarding “or those boards” seems like it might open the door for ABPM with some petitioning or something.

What do you guys make of this? I have heard from others that ABPM will get involved with issues regarding privileges etc. Is there more to this picture than meets the eye?

Thanks in advance for everyone’s take

I have ABPM only. I’ve thought about doing ABFAS but I haven’t. I’ve gone through the credentialing process 3 times with no issues.

I don’t do much surgery and I’m transitioning to no surgery in the next few months. At the end of the day ABFAS is pointless for me. It might not be for you.