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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[newfeet]

So why did 6 members of the ABPM board just resign? It has been presented on this site that their entire board was behind the ABPM initiatives, yet an exodus like this would tend to indicate a major rift or problem from within. It would seem like for as much "we are for everyone" chatter that has been occurring, there would be some statement aside from "per the bylaws....." For the record, I have absolutely no inside knowledge of any kind, but I am surprised no one is talking about it. (Unless I missed it somewhere)

Maybe they were behind everything until the backlash. They probably signed non disclosures at some point. So we will never know.

 

[shadesofgrey]

Feli, maybe the fact that you don’t really need ABFAS plays into your support of them. You admit your privileges are safe and you will be fine even if you don’t pass this time. You’ve put in a good chunk of your career using qualification status and admitted it’s largely a personal goal to get the certification at this point. However, not all are as fortunate. Most of us will suffer professional harm without gaining ABFAS certification.

I will acknowledge that passing the ABFAS tests and case review is more difficult that abpm. What I do not agree with is that 1) that the process is fair 2) that passing said tests corresponds to surgical skill. You actually are a perfect example of why the system is broken. You are presumably an excellent surgeon, but haven’t gained RRA certification. If you functioned under current rules then you missed your chance, sorry, but time expired. In many hospitals and even some entire states, no RRA for you. You have largely attributed your inability to pass RRA to changing jobs and not having access to records from old employers. Is that a reasonable excuse? Yes. Does this in any way reflect your surgical skills? Of course not. Is it fair that you still have an opportunity to become certified while any new doc who experiences your situation is screwed in the future? No. I understand life ain’t fair but don’t expect me to cheer for the board who’s broken system will screw me over if I don’t become certified. Say what you want about ABPM but it’s ABFAS that is trying to change state laws and hospital bylaws. They brought this vitriol on themselves.

Im not sure what happened with the ABPM board, looks sketchy as ****. Regardless I remain supportive of the ABPM actions; not because I am loyal to ABPM/Dr. Rogers per se but because they are directly opposing ABFAS. Even as I seek ABFAS certification, I remain appalled that a system that could screw over so many young docs is just accepted as part of the process. Its broken as ****.

 

[MoostashPod]

Feli, maybe the fact that you don’t really need ABFAS plays into your support of them. You admit your privileges are safe and you will be fine even if you don’t pass this time. You’ve put in a good chunk of your career using qualification status and admitted it’s largely a personal goal to get the certification at this point. However, not all are as fortunate. Most of us will suffer professional harm without gaining ABFAS certification.

I will acknowledge that passing the ABFAS tests and case review is more difficult that abpm. What I do not agree with is that 1) that the process is fair 2) that passing said tests corresponds to surgical skill. You actually are a perfect example of why the system is broken. You are presumably an excellent surgeon, but haven’t gained RRA certification. If you functioned under current rules then you missed your chance, sorry, but time expired. In many hospitals and even some entire states, no RRA for you. You have largely attributed your inability to pass RRA to changing jobs and not having access to records from old employers. Is that a reasonable excuse? Yes. Does this in any way reflect your surgical skills? Of course not. Is it fair that you still have an opportunity to become certified while any new doc who experiences your situation is screwed in the future? No. I understand life ain’t fair but don’t expect me to cheer for the board who’s broken system will screw me over if I don’t become certified. Say what you want about ABPM but it’s ABFAS that is trying to change state laws and hospital bylaws. They brought this vitriol on themselves.

Im not sure what happened with the ABPM board, looks sketchy as ****. Regardless I remain supportive of the ABPM actions; not because I am loyal to ABPM/Dr. Rogers per se but because they are directly opposing ABFAS. Even as I seek ABFAS certification, I remain appalled that a system that could screw over so many young docs is just accepted as part of the process. Its broken as ****.

Bravo! 👏 Amen. I feel the same.

 

[Feli]

Maybe they were behind everything until the backlash. They probably signed non disclosures at some point. So we will never know.

This should not be the way it should be... hidden info, NDAs, silence.

These are people elected and paid for service to a paying membership (well, now it's a joke BOD of appointees, but ideally it's not, and it wasn't a couple weeks ago). Heck, at least they voted with their feet. These are people who had been with the ABPM for years, were exam writers, were ambassadors, some were in line to be future VP and pres... and they walked out abruptly. Anyone who can't read that is blind to the goings-on.

What's done is done, but there has to be discovery of ABPM meeting minutes from this mysterious last meeting below, immediately before the entire BOD resigned. If there is not information available as to whether an impeachment of ABPM president was attempted (and how that vote went), what was discussed that caused the exodus, the timing of resignations, etc... then that's even more crooked than what's already transpired in ABPM recently (conflict, prez speaking for BOD repeatedly when they were clearly not on board). And yeah, of course LCR wants to sweep it under the rug and move on, but the membership and DPMs deserve to know a bit about what a recognized board quickly put under that rug and stacked a whole new green BOD into place...

...There were several resignations of ABPM BOD. I am grateful to all of them for their hard work on behalf of our Board and our profession. But, as is evident here, the politics of podiatry can be tough on our leaders and disruptive to people’s lives. Personal attacks are completely inappropriate.

Those vacancies were filled by appointment in accordance with our bylaws. The appointees are a diverse group of young leaders who have first-hand experience with how ABPM’s advocacy can help remove barriers to practice. I am confident they will pay-it-forward for our next generation of young DPMs navigating the board certification process and entering practice. Please respect them as they become oriented in their new role.

It is true, and I’m not at all ashamed to reveal that I approached a couple Diplomates who are part of the SDN community to see if they were interested being nominated to the BOD.

Two weeks ago, about 40 people, including the entire ABPM BOD and several committee members along with staff and other interested parties met at ABPM HQ. We created a strategic plan...

 

[Feli]

...You are presumably an excellent surgeon...

Hey, hey, hey... I have posted a my lot of XRs here on SDN over the years. Strike "presumably!" Make it "occasionally."
...I'm kidding, I struggle on cases occasionally just like anyone... but yeah, my surgical principles and prep and training are strong, and I am interested in it. I tend to take on cases that few in my area do, and they tend to go well if I plan and communicate with the pts. It's good.

...I understand life ain’t fair but don’t expect me to cheer for the board who’s broken system will screw me over if I don’t become certified. Say what you want about ABPM but it’s ABFAS that is trying to change state laws and hospital bylaws. They brought this vitriol on themselves.

Im not sure what happened with the ABPM board, looks sketchy as ****. Regardless I remain supportive of the ABPM actions; not because I am loyal to ABPM/Dr. Rogers per se but because they are directly opposing ABFAS. Even as I seek ABFAS certification, I remain appalled that a system that could screw over so many young docs is just accepted as part of the process. Its broken as ****.

I agree fully. ^

ABFAS needs to change. The exams are fine; they could always improve. Overall, the case accumulation and review is a broken process that nitpicks and grades documentation and longevity at jobs as much as it does that the DPM is doing the cases and knows their stuff. You have a guy tell you on the phone to proceed with submitting cases that are suffering from documentation that's fragmented or missing XRs, and then you fail case review. Not fun. If I finish and fail, I might post my full fail reports (they dont' have pt names, just numbers) for assistance to BQ candidates. Here are a few from last year:
"The physical exam indicates continues swelling and discomfort to the foot." (cut-n-past f/u notes obviously, as we almost all do)
"Inadequate documentation of biomechanical evaluation of first ray. " (this was 3 or 4 times... not joking)
"Inadequate clinical documentation to justify procedure selection."
"Unable to assess due to quality of images in a camwalker." (I do PACU post-op through boot/shoe to avoid pt pain, so fail if the pt delayed or resched appt for 5-7d f/u)
...It's sad. Most of that stuff (biomech, indications, etc) are already tested on the didactic and CBPS.

Again, the current ABFAS prez is an alumni of my residency program, and so are other past presidents, BOD, etc. When I did the program maybe a decade after, it was at a much bigger teaching hospital, more attenings, more cases, better off-service and research support, etc than the current prez. That still doesn't earn me a free cert... nor should it.
Of my co-residents who passed RRA cert had to grit out his PP job when he had long concluded he was underpaid for his production and wanted out. He did hang on a couple more years, mainly to pass ABFAS (not first try)... and he jumped ship as fast as he could afterwards. The proper thing would have been for him to pass all didactic exams at the finish of residency (he did, we all did), and then for the ABFAS to eval maybe 5+5 or 10+10 of his foot+RRA cases within a couple of years of residency - like ortho, gen surg, plastics, etc do it. Then, he's free to move about the country. Likewise, if case reqs and review were more logical (fewer cases and just hospital logs), then I could have gotten ABFAS cert without delay and delaying due to wanting to find better jobs and situations. People wouldn't be afraid to start their own PP out of residency for fear of not enough surgery fast enough for ABFAS cert. Others take a job that gives a lot of surgery for ABFAS over a job with a DPM they like or a job where they want to be. It's illogical.

However, I don't feel it's fair to ding me, or anyone, for playing by the rules I'm given (re-qual allowed for pre-2014 grads, tests may have been easier/harder back in the day, etc... it was what it was, is what it is). For all we know, maybe I would have bit the bullet and stayed at one of my $80k associate jobs to try cert earlier if I didn't have the re-qual option. It also shows you I'm pretty versed in F&A surgery if I can pass fairly tough tests out of training and pass them again many years later... when a lot of graduating residents can't pass them at all. Everyone plays with the rules they are given.

...ABFAS is suboptimal, but it's what we have. It does need to improve. We shouldn't even have Foot and RRA. Case review needs to be much more basic, or even just hospital logs, and f2f for sure (whether standardized cases, like gen surg or OB... or your own, like ortho or plastics). So, I won't take sides blindly, but ABFAS is absolutely the far superior board in terms of standards, good minds who are loyal to it, training and competence of diplomats, cooperation, professionalism... any metric you can pick. And the ACFAS is bar none the most amazing thing in all of podiatry (cough cough... F&A surgery!). They are legit for meetings, journal, intellect. I loved that as a student and still do.

ABPM is a dumpster fire. It's sad to see. They won't even be able to function at this point... it will be tough to even keep their basic core BC exam afloat with the corrupt and rapid hockey-style line change of BODs. APMA needs to axe their prez and new "board" he appointed, and let the ABPM organization be on probation and begin anew with a small handful of elected officers or existing/departed officers who are interviewed by an outside neutral party and deemed to be non-corrupt. It's obvious they can't regulate themselves at this point. I'm not ruling out an overhaul for ABPM, but I was unimpressed in 2022 with the surgery CAQ talk and its execution.
Now, prior to that BS, which was done just to cause conflict and from prez vendetta, I'd strongly considered keeping ABPM membership even if I got ABFAS cert. Now, I don't even want to be in ABPM at all. It's malignant right now. I feel terrible for the ABFAS prez who has his term essentially made into a circus by the ABPM (well, its prez). It's too bad that the whole prior BOD of ABPM got bamboozled to the point where they had to resign this week, and it's a shame smart people like Dr Ford got sucked into the nonsense CAQ and anti-ABFAS plan of a power-hungry goofball. But yeah... I'll definitely gravitate to the much lesser of two evils among podiatry boards and hope that improves.

 

[ChartingChad]

Wait quick question... what do you mean "re-qualification allowed for pre 2014 grads?"

I'm under the impression you have 7 years to get board certified after graduation from residency. If you fail this, can you get board qualified again or take the exam again? I thought you were just done with no additional chance to pass.

 

[Steveington]

Of my co-residents who passed RRA cert had to grit out his PP job when he had long concluded he was underpaid for his production and wanted out. He did hang on a couple more years, mainly to pass ABFAS (not first try). The proper thing would have been for him to pass all didactic exams at the finish of residency, for the ABFAS to eval maybe 5+5 or 10+10 of his foot+RRA cases within a couple of years of residency - like ortho, gen surg, plastics, etc do it. Then, he's free to move about the country. Likewise, if case reqs and review were more logical (fewer cases and just hospital logs), then I could have gotten ABFAS cert without delay and delaying due to wanting to find better jobs and situations. People wouldn't be afraid to start their own PP out of residency for fear of not enough surgery fast enough for ABFAS cert. It's illogical.

ABFAS contributes to podiatry's low wages. Associates are not willing to leave their underpaid positions for fear of missing out on board certification.
Leaving my first job tripled my salary, but lost all those cases/documentation/imaging from that first practice.

 

[Feli]

Wait quick question... what do you mean "re-qualification allowed for pre 2014 grads?"

I'm under the impression you have 7 years to get board certified after graduation from residency. If you fail this, can you get board qualified again or take the exam again? I thought you were just done with no additional chance to pass.

page 19 below... DPMs who finished residency pre-2014 had option to re-take the qual exams and be BQ another 7 years... I did that option. That's what he was teasing me for.

https://www.abfas.org/docs/default-source/abfas-documents/bcdoc.pdf?sfvrsn=bd0d35f1_75

ABFAS is kinda trying to scrub re-qual from the history book as best they can, but it's a thing. They don't show those who are still BQ via re-qual in recently published pass rates, barely mention it in the rules for qual and cert, etc. The 2014 grads and onward are done with BQ status after 7yrs, yes. I don't think they gave any extensions for COVID either (if they did, it was very discreet).

Some of the pre-2014 also had to deal with film XRs, paper charts, etc. I have had either or both at some past jobs.
It's just like how the old old timers had the F&A cert from ABFAS or more lax (rumored some had no) case reqs.. but very few DPMs got surgical programs in those years.
Every generation or era has its unique struggles and various rules... and every new one thinks they have it hardest.

Like I said, each plays by their own rules. They made due with what was in place at the time.
NFL rules for DBs have changed and they have 17 games now.
Baseball changed a ton of stuff this year with pitchers and base size and such.
Tons of historically love and successful and popular people would be judged as sexist, racist, etc by today's standards.
Just play on the best you can in the time you exist...

 

[Boba Foot]

I'll definitely gravitate to the much lesser of two evils among podiatry boards and hope that improves.

Literally what incentive does ABFAS have to improve? Residents are forced into ITE exams because their residencies are forced to pay for it even though the exam is shoddily written and has an abysmal pass rate. The ****tier the exam is, the more residents fail, the more retakes, the more $$. It doesn't take an MD to see what's going on here.

The ONLY reason people put up with this **** is because 1) as a new residency grad it can "help your job prospects" and 2) ABFAS cert docs at hospitals are using it to gate-keep so if you want to operate there you have to pay to play. Gotta pay the troll toll.

As long as they can keep positioning themselves as *the* board cert, they have ZERO reason to improve ANYTHING. Why that is a lesser of any evils to you is beyond my fckin mind.

 

[Feli]

...Residents are forced into ITE exams because their residencies are forced to pay for it even though the exam is shoddily written ...

This mandatory ITE you speak of was actually the work of the ABPM past-president... the guy who has the one dissent vote needed to save LCR from being unanimously removed by the [now resigned] ABPM board.

They wanted the $ from required in-training exams for ABPM power and visibility. It worked. ABFAS didn't really care whether ITE were mandatory or not. Why would they care? Sure, it helped ABFAS a tiny bit also, but nearly every residency program was already taking ABFAS in-training, but very few took ABPM... prior to it being mandatory and 320 cpme document re-write (largely by homeboy).

So, the plot thickens, huh?

...but yes, ABFAS can improve. I agree. They have little incentive to. Agree x2. That doesn't make ABPM trash turn into gold pieces, though. We can't connect dots that aren't even on the same page or in the same book.

 

[Boba Foot]

You're admitting that ABFAS has room for improvement and has little reason to do so, and then ABPM attempts to disrupt the space to force change and you wing-man ABFAS why? Because you dislike Dr. Rogers that much? Because you love ABFAS that much? Because you really think FACFAS DPMs are that enlightened?

No plot has thickened, ABFAS is still gate keeping with a trash exam and trash process. The politics and conspiracy theories really mean nothing to most pods such as myself. We just want to recover whatever ROI we can in this career without worrying about another goddamn roadblock trying to gatekeep us.

 

[Adam Smasher]

Literally what incentive does ABFAS have to improve? Residents are forced into ITE exams because their residencies are forced to pay for it even though the exam is shoddily written and has an abysmal pass rate. The ****tier the exam is, the more residents fail, the more retakes, the more $$. It doesn't take an MD to see what's going on here

Sorry, I must be misremembering. When I was in residency (2014-17) we all thought the both of the in training exams were super easy. Like pointless waste of time what am I supposed to be proving easy. Not the best written, but easy enough to get through. Are there consequences to doing badly?

Also do they still teach that digital clubbing is pathognomic for bronchogenic carcinoma 🤣?

 

[myfeetrkillingme]

Wait quick question... what do you mean "re-qualification allowed for pre 2014 grads?"

I'm under the impression you have 7 years to get board certified after graduation from residency. If you fail this, can you get board qualified again or take the exam again? I thought you were just done with no additional chance to pass.

I believe you have seven years once you are Board qualified not graduate, if BQ was don’t at a later date.

 

[RollingstonePod]

ABFAS contributes to podiatry's low wages. Associates are not willing to leave their underpaid positions for fear of missing out on board certification.
Leaving my first job tripled my salary, but lost all those cases/documentation/imaging from that first practice.

ABFAS is aware that BC candidates who leave a PP may encounter an employer who is unwilling to provide patient data for BC. ABFAS has a history of reprimanding such employers if they are ABFAS diplomates. Not sure if BC candidates know this.

Not much they can do for candidates previously employed by VA, multi-specialty groups, etc.

 

[dtrack22]

ABFAS is aware that BC candidates who leave a PP may encounter an employer who is unwilling to provide patient data for BC. ABFAS has a history of reprimanding such employers if they are ABFAS diplomates. Not sure if BC candidates know this.

Or ABFAS could, you know, have a defined logging period within the 12 months prior to case review like the board who certifies actual Foot and Ankle surgeons (ABOS). Then you don’t even have to worry about what your boss from 3 years ago may or may not provide from a patient data standpoint.

 

[RollingstonePod]

Or ABFAS could, you know, have a defined logging period within the 12 months prior to case review like the board who certifies actual Foot and Ankle surgeons (ABOS). Then you don’t even have to worry about what your boss from 3 years ago may or may not provide from a patient data standpoint.

While that sounds like a good solution, case diversity would probably be an issue for many. I could see a solution possibly being to choose cases within 12 months of the case diversity requirement being met. Logging would still need to occur from the time of BQ though.

 

[dtrack22]

While that sounds like a good solution, case diversity would probably be an issue for many.

What happens if ortho doesn’t do any foot or hand surgery during their logging/case list period? Oh yeah, that’s right they don’t have a diversity requirement and they still get to sit for boards. And despite operating on 10x as many body parts, they only get 12 cases selected, not 24 or whatever insane number ABFAS is up to. I do not believe Gen surg or Urology or OBGYN have any diversity requirements either, for that matter. Get rid of the diversity requirement. If you aren’t doing ankles then you don’t do ankles and your local facilities will be the gatekeepers which is how the system is set up for every surgical specialty…other than podiatry.

Logging would still need to occur from the time of BQ though.

What other specialty logs every case they’ve ever done (even though a significant % will admittedly never be selected for review), between BQ and BC?

New account, defending ABFAS process…you guys, I think one of them took the mods up on their offer and decided to roll around in the mud with the degenerates of SDN. Welcome.

 

[PalpablePulse]

While that sounds like a good solution, case diversity would probably be an issue for many. I could see a solution possibly being to choose cases within 12 months of the case diversity requirement being met. Logging would still need to occur from the time of BQ though.

Rolling stone Pod? I presume you are a member and part of leadership at ABFAS, and as such - no point in someone like you remaining anonymous. Why doesn’t ABFAS and the rest of podiatry leadership start by taking some accountability - instead of just taking dollars from its members?

I’ll await your reply, and the mods will await your private complaints about how it’s so unprofessional here.

 

[RollingstonePod]

Rolling stone Pod? I presume you are a member and part of leadership at ABFAS, and as such - no point in someone like you remaining anonymous. Why doesn’t ABFAS and the rest of podiatry leadership start by taking some accountability - instead of just taking dollars from its members?

I’ll await your reply, and the mods will await your private complaints about how it’s so unprofessional here.

I find all the complaining comical, you will not hear any complaints from me about being unprofessional. I've been through the BC process successfully and know the inner workings of both organizations. You speak of accountability, for what exactly?

 

[PalpablePulse]

I find all the complaining comical, you will not hear any complaints from me about being unprofessional. I've been through the BC process successfully and know the inner workings of both organizations. You speak of accountability, for what exactly?

Accountability for a flawed boards process. And I say that as a diplomate.

Accountability for creating an environment where low salaries and wages are commonplace.

You are leaders in foot and ankle surgery and protecting the public after all.

Have you read through these threads at all?

 

[DMEpod]

Say what you will about the ABPM, which obviously has its own issues, but ABFAS seems much more polar. After graduating within the past two years there are very few of my co residents and students that are even entertaining ABFAS BC. The ITE is an awful exam with few relevant topics and the BC process is drawn out, expensive, and cumbersome. Having to log every case, from multiple locations and hoping that you are still at the same job for the next 5 years is not a key to success for many new pod grads. I feel that in a few years when ABFAS notices less new grads paying for their process things might change. Until then I welcome some competition and change brought on by the ABPM, even if it is flawed in ways.

 

[PalpablePulse]

Say what you will about the ABPM, which obviously has its own issues, but ABFAS seems much more polar. After graduating within the past two years there are very few of my co residents and students that are even entertaining ABFAS BC. The ITE is an awful exam with few relevant topics and the BC process is drawn out, expensive, and cumbersome. Having to log every case, from multiple locations and hoping that you are still at the same job for the next 5 years is not a key to success for many new pod grads. I feel that in a few years when ABFAS notices less new grads paying for their process things might change. Until then I welcome some competition and change brought on by the ABPM, even if it is flawed in ways.

Another poster has said as much. The current boards process feeds into malignant and predatory private practices employing associates and using board certification cases as a carrot to keep them around.

And no, a written warning does nothing from ABFAS in order to get those docs to give those cases to associates. You aren’t Medicare, no one cares. Source: PERSONAL EXPERIENCE. We all have to play by your stupid rules none the less.

So who are you? Be brave.

 

[RollingstonePod]

Accountability for a flawed boards process. And I say that as a diplomate.

Accountability for creating an environment where low salaries and wages are commonplace.

You are leaders in foot and ankle surgery and protecting the public after all.

Have you read through these threads at all?

I have read through some of the latest threads on current issues. You are correct, "protecting the public" is the goal. While the board process is not perfect, it has morphed over the years, for the better. Like it or not, hospitals use board certification as a "threshold criteria" and consider BC as a benchmark for delineation of clinical privilege's. That is not going away. Every hospital I have been on staff at has required BC within 5 years and if that includes surgical privileges then ABPS/ABFAS is the benchmark. Despite what many on these threads think, ABFAS does not make hospital policy nor do they lobby for this language to be in any bylaws or state scope laws.

The most insightful thing I have read so far on this forum is the following:

"The residency training (and pod school admissions) part is the the elephant in the room."

 

[Shiyuan]

The current boards process feeds into malignant and predatory private practices employing associates and using board certification cases as a carrot to keep them around.

100000%

This is the ABFAS way.

“Protecting the public” is a line of bologna. Ask any MD/DO/PA/NP/Hospital admin/janitor/patient the difference between ABPM and ABFAS and they will go 🤷🏻‍♂️

ABFAS protects their own and gatekeeps everywhere. Podiatrist vs. podiatrist. Self destructive.

 

[Pronation]

The current boards process feeds into malignant and predatory private practices employing associates and using board certification cases as a carrot to keep them around.

This is indeed a glaring issue in our profession. Of course the underlying problem stems from severe over saturation.

 

[DMEpod]

"The residency training (and pod school admissions) part is the the elephant in the room."

You are correct. This is a huge glaring issue. That does not take away from the fact that the ABFAS is a predatory monopoly that forces new grads to practice a certain way to obtain a certification that many do not even want to use in the long run. If one hypothetically just want to do amps and ride the pus bus, why must they log bunions and fractures to satisfy some random pod that might fail them anyways from lack of notes or info...

 

[msion]

Despite what many on these threads think, ABFAS does not make hospital policy nor do they lobby for this language to be in any bylaws or state scope laws.

Are you sure?

"[...]for hospitals which require board qualification or certification to obtain credentials and privileges to perform podiatric surgery, ABFAS certification is the credential that best demonstrates a candidate’s relevant qualification, competence, and expertise for surgical privileges."

Sure ABFAS doesn't make hospital policy... they just keep sending letters with statements like this to hospitals, or encourage their members to do that as well.

And what's up with the Oregon ankle scope law that required ABFAS? When ABPM filed the lawsuit against the Oregon board, somehow ABFAS released statement condemning ABPM's actions? Why?

Whenever I see hospital bylaws that require ABFAS, with certification course for ankle scopes. I instantly know ABFAS and a DPM were behind this. Pretty soon I am gonna see bylaws that require AO internal fixation courses as well

 

[newfeet]

I have read through some of the latest threads on current issues. You are correct, "protecting the public" is the goal. While the board process is not perfect, it has morphed over the years, for the better. Like it or not, hospitals use board certification as a "threshold criteria" and consider BC as a benchmark for delineation of clinical privilege's. That is not going away. Every hospital I have been on staff at has required BC within 5 years and if that includes surgical privileges then ABPS/ABFAS is the benchmark. Despite what many on these threads think, ABFAS does not make hospital policy nor do they lobby for this language to be in any bylaws or state scope laws.

The most insightful thing I have read so far on this forum is the following:

"The residency training (and pod school admissions) part is the the elephant in the room."

A podiatrist in NY can not get a special ankle permit without ABFAS RRA certification. So someone lobbied for that. Maybe it wasn’t an official ABFAS position but it’s there.

 

[Feli]

Say what you will about the ABPM...

I do. Repeatedly... once the 2022-23 and CAQ antics began.

This guy beat me to it this week:
Podiatry Management Online

"
05/02/2023 Steven Spinner, DPM

ABPM Appoints 6 New Directors

Congratulations to the ABPM Board. I would like to
send my personal vote of gratitude and appreciation
to those ABPM board members who recently resigned
their positions voluntarily. I am sure that it was
not a decision that was arrived at with light
hearts, because I am sure that they have a love for
their profession and their organization. However,
after the disruption and inappropriate behavior of
the president, Dr. Lee Rogers, I am sure that in
their conscience they had no other choice.

It is disappointing however, that the board could
not unanimously decide to remove him as the
president. It continues to amaze me how after every
major organization within our profession, including
most recently, the American Podiatric Medical
Students Association has come out in no uncertain
terms against policies recently enacted by Dr.
Rogers. It amazes me that he continues to exist in
this position. His continued presence is a cancer
that is growing from within and has done nothing
but aggrandize his own ego.

He states that he is for every podiatrist? The only
podiatrist that he is for clearly is himself. If he
had any conscience whatsoever he would have
resigned a long time ago and let people with a
clear head and pro- podiatry agenda run the
American Board of Podiatric Medicine. His addition
of a CAQ in Podiatric surgery is clearly a move
that directly attacks the sovereignty of the
American Board of Foot and Ankle Surgery.

His clear agenda is to allow every podiatrist who
so desires to advertise themselves as a podiatric
surgeon by advertising that he has a CAQ in surgery
simply by passing minimal requirements. To the
unknowing public that sounds at least as good, and
possibly better than just having board
certification in Podiatric surgery. At the least it
is confusing and at the most. It is harmful to the
public. There is clearly a role for our two boards.
I believe that every podiatrist has a right and
should have access to board certification.

ABPM should serve all of those podiatrists who can
meet the requirements for certification in a number
of different specialties within our profession.
ABFAS should clearly credential those podiatrists
with advanced training, and can meet those advanced
requirements to pass the surgical board. This will
not deny any podiatrist in our country access to
any hospital, or any insurance company.

I believe that board certification should not be a
gatekeeper to get on plans or hospital staffs. The
criteria for stepping into the operating room
should be demonstrating what you are capable of…
based on your cases, your experience, and your
training. Remember, and it may sound idealistic,
but the role of board certification is to protect
the public not the doctor.

It has also disappointing me that our national
organization has not had teeth to do something
about Dr. Lee Rogers. Fortunately, his board or at
least most of it, has a conscience. Kudos to them!

Steven Spinner, DPM, Plantation, FL"

Kudos for keeping it real. Lee made a joke of ABPM. That's a shame. It's now a corrupt board of people obviously put into place to continue an unpopular mission after Dr Rogers' lies that his mission was the whole ABPM's mission, and that fallout and obvious vote of no confidence should be de-funded by APMA and put ABPM on probation until a house-cleaning can occur.

 

[Feli]

While that sounds like a good solution, case diversity would probably be an issue for many. I could see a solution possibly being to choose cases within 12 months of the case diversity requirement being met. Logging would still need to occur from the time of BQ though.

This is on the right track, but the fact that we even need case diversity at all or RRA/Foot delineation is just - not - true.

It's friggin foot surgery. It's already highly limited.
Surgical principles and knowledge for a DPM are strong, or they are not... and much of that is already tested on the didactic BQ anyways.

Fracture reductions are fx reductions. Osteotomies are osteotomies. Fusions are fusions. Amps are amps. Skin closures are skin closures. The underlying principles and knowledge and prep and execution are what makes them successful or unsuccessful/dangerous. Bottom line.

This is why ortho just does a basic BC (part 2) test after a year or two into practice on their XRs. Plastics does it on photos. GSurg and OB and ENT do standardized cases workups f2f discussed with senior surgeon (this was what I did for NC Pod license... tough but fair). The diversity and the resultant prolonged BQ period and the delineation of the specialty BQ/BC into parts of an already small anatomy are uniquely podiatry.... and it should be ended.

...Anyone who does surgery - pod or otherwise - has done things they never did in residency, new stuff evolves, new implants arrive, pathology comes in spurts... whatever. The knowledge and competence with the instruments and principles and knowledge to plan and handle complications are what matters.

And yeah, a lot of DPM residencies are garbage. I get that. The ABPM is a steaming pile right now. None of that is ABFAS' fault... that's more on the schools for taking in more students than good residency spots exist for and the ABPM to certify the surplus, but we still can't leave so many DPMs marooned in terms of being BC for surgery awhile - or ever - just because they can't get certain referral types fast enough or because their XRs get ticky-tacked on review or because past cases are not accessible. As mentioned above, the process needs to be improved.

*edit to add: I had non-pod surgeon PM me to state that they do need case/hospital logs for pt 2 (oral) boards, and proceed to standarized cases as I'd stated above. I didn't mean to imply they don't have to build hospital/case logs. Also, their logs/cases can be discussed at pt2... the case logs are a requirement but not a major hindrance to sitting for p2 or failing it (as they are in podiatry / ABFAS)*

 

[RollingstonePod]

Are you sure?

"[...]for hospitals which require board qualification or certification to obtain credentials and privileges to perform podiatric surgery, ABFAS certification is the credential that best demonstrates a candidate’s relevant qualification, competence, and expertise for surgical privileges."

Sure ABFAS doesn't make hospital policy... they just keep sending letters with statements like this to hospitals, or encourage their members to do that as well.

And what's up with the Oregon ankle scope law that required ABFAS? When ABPM filed the lawsuit against the Oregon board, somehow ABFAS released statement condemning ABPM's actions? Why?

Whenever I see hospital bylaws that require ABFAS, with certification course for ankle scopes. I instantly know ABFAS and a DPM were behind this. Pretty soon I am gonna see bylaws that require AO internal fixation courses as well

Anywhere you see ABPS/ABFAS as a requirement for any type of privilege, you can be assured it was an individual or a group of individuals making the recommendation, e.g. chief of podiatry at a hospital writing credentialing guidelines or negotiations of DPM individuals wanting state scope laws changed to allow ankle surgery by DPM's. This was the case for NY and OR law (and other states) including RRA cert as a requirement for ankle privileging. ABFAS has nothing to do with the guidelines being written at any hospital or state.

 

[Utvolsdpm]

Anywhere you see ABPS/ABFAS as a requirement for any type of privilege, you can be assured it was an individual or a group of individuals making the recommendation, e.g. chief of podiatry at a hospital writing credentialing guidelines or negotiations of DPM individuals wanting state scope laws changed to allow ankle surgery by DPM's. This was the case for NY and OR law (and other states) including RRA cert as a requirement for ankle privileging. ABFAS has nothing to do with the guidelines being written at any hospital or state.

Yea it’s pretty ridiculous. Some old foagies got grandfathered in, then tried to use it as a gate keeping method to keep younger/new pods out of their territory.

It’s kind of silly to think there were people without a surgical residency who became ABFAS certified or others who never trained doing RRA cases and picked up some skills in practice that are now RRA certified. The same board okaying this up in arms about a CAQ over “confusion” and “patient safety”

 

[shadesofgrey]

Feli,

I think we are in agreement over most of our postings. I think your situation just highlights the unreasonable and onerous nature of the ABFAS certification pathway. You are a good surgeon who may not attain RRA certification for BS reasons. Our difference is just you view LCR and ABPM in worse light than ABFAS. I've talked to LCR only twice at conferences and have no history with him to taint my view of the ABPM. Meanwhile, in my opinion, ABFAS is the enemy of the young practitioner, plain and simple. The low pass rate, required timeline, and push to limit privileges without ABFAS certification is directly harmful to graduating docs.

I bring the rule change up, not to harass you but to try and get you to realize why some of us are siding with ABPM. You have RRA privileges despite lack of ABFAS certification, many of us won't. Should you have been prohibited from doing RRA surgery at 7 years? No. It's senseless. I'm not upset at all that you played by the rules you were given. I am upset that the rule exists in the first place. I can't see any point to not allowing qualification or certification status to be attained past the 7 year mark. It allows no flexibility for job changes, family planning, or world wide pandemic.

I view ABPM as more of a, "the enemy of my enemy is my friend" situation. I hold no loyalty to them. If they can either provoke changes to the ABFAS or become the board of choice then I am pleased. In general ABPM is largely harmless even with the recent drama. What's everyone worried about? "Oh god no! Dr. Roger's, after years of planning, has pulled off a coup and is now in charge of the second most powerful podiatry board in the country!" With that kind of power, he could do what exactly? Honestly what's the harm? Are we worried about the perception of the whole thing? I've read enough accounts to accept that Dr. Rogers doesn't play well with others but last time I checked ABPM was trying to open access to hospitals for pods. Did ABFAS say it was inappropriate and try to prevent Oregon from closing the ankle to most of their own podiatrists?

 

[shadesofgrey]

Anywhere you see ABPS/ABFAS as a requirement for any type of privilege, you can be assured it was an individual or a group of individuals making the recommendation, e.g. chief of podiatry at a hospital writing credentialing guidelines or negotiations of DPM individuals wanting state scope laws changed to allow ankle surgery by DPM's. This was the case for NY and OR law (and other states) including RRA cert as a requirement for ankle privileging. ABFAS has nothing to do with the guidelines being written at any hospital or state.

So then I assume you/ABFAS would support the expanding of privileges to include those without ABFAS status but who can show adequate training?

 

[RollingstonePod]

So then I assume you/ABFAS would support the expanding of privileges to include those without ABFAS status but who can show adequate training?

Training, as has been said on this forum, is highly variable. Adequate training does not necessarily translate into proficiency or minimal competency in foot surgery. If an individual has "adequate training" and can demonstrate competency then I would not have a problem extending privileges despite an ABFAS designation.

 

[air bud]

Who here is saying they have been limited by being BQ only? I was BQ for 4 years and it didn't limit me whatsoever.

 

[msion]

Who here is saying they have been limited by being BQ only? I was BQ for 4 years and it didn't limit me whatsoever.

I think once established BQ/BC status really isn't all that important. It affects the ones looking for new positions or relocating to another area.

That being said, BQ is good for 7 years. And honestly after 7 years with all everything is going in medicine, I may not want to do surgeries anyway. The old style of going to school for 10+ years and then practice for another 30 years is just less and less feasible nowadays. If it's affecting an old soul like me, then I am sure the ones born after the 21st century will not accept the status quo.

 

[Pronation]

Who here is saying they have been limited by being BQ only? I was BQ for 4 years and it didn't limit me whatsoever.

I was not considered for many hospital positions because I was not certified.

 

[air bud]

I was not considered for many hospital positions because I was not certified.

Yeah, but how much of that is just inherent to the job market and the positions available. Somebody who certified is going to have more experience and a hospital knows they can be more selective so they're going to want somebody with more experience. So you go rural like I did get cases get certified and then you can in theory do whatever you want... It's just the game that you have to play..... Because wait for it..... Podiatry.

In any industry, the jobs that are most competitive they're going to want the people with the most experience and the most highest level of talent and that takes time to develop and achieve and so this is not a Podiatry specific thing.

 

[Pronation]

Yeah, but how much of that is just inherent to the job market and the positions available. Somebody who certified is going to have more experience and a hospital knows they can be more selective so they're going to want somebody with more experience. So you go rural like I did get cases get certified and then you can in theory do whatever you want... It's just the game that you have to play..... Because wait for it..... Podiatry.

In any industry, the jobs that are most competitive they're going to want the people with the most experience and the most highest level of talent and that takes time to develop and achieve and so this is not a Podiatry specific thing.

Yup. Basically all of this is a product of massive over saturation.

 

[shadesofgrey]

Who here is saying they have been limited by being BQ only? I was BQ for 4 years and it didn't limit me whatsoever.

Was this directed at my posts?

 

[RollingstonePod]

You are correct. This is a huge glaring issue. That does not take away from the fact that the ABFAS is a predatory monopoly that forces new grads to practice a certain way to obtain a certification that many do not even want to use in the long run. If one hypothetically just want to do amps and ride the pus bus, why must they log bunions and fractures to satisfy some random pod that might fail them anyways from lack of notes or info...

I think your indignation towards ABFAS is misguided. ABFAS happens to be the recognized board, certifying DPM’s in foot and ankle surgery. It does not certify podiatrists in bunion surgery, hammertoe surgery, or riding the pus bus surgery. They certify podiatrists in comprehensive foot surgery. With the certificate, a credentialing organization knows the individual has met minimum competency in FOOT SURGERY. To say they are predatory and force new grads to do anything is ludicrous. They are no different than any of the other board of the ABMS. Your angst should be directed to the hospitals, states, or any other organization that requires ABFAS certification.

 

[air bud]

Was this directed at my posts?

No absolutely not, more of a general observation/question

 

[Feli]

...They are no different than any of the other board of the ABMS. ...

Pass rates are quite different. ^^
The % of DPM grads who even pass ABFAS BQ or even eventually try to sit for BC ("sit" is the antiquated term... submit online) is much different than ABMS boards. It is significantly lower. That's multi-factorial, but it is nowhere close to ortho, gen surg, any of them in terms of % of residency grads who go on to become cert.

So, let's just...

• Remove the accreditation for all of the bad DPM residencies and reduce/consolidate spots at ones that are salvageable.
• That'd force pod schools to be a bit selective and keep enrollment to reasonable number based on quality residency spots (or knowingly create/worsen residency shortage, which would scare off students... so, either way).
• That would allow for better training and more surgery per young DPM and eventually get ABFAS pass rate to 90 or 95%... like MD surgery boards?

That was easy. It'd actually fix jobs/income as well as boards/respect in the same fell swoop. But we can't say we are like MD boards when residency spots/standards and cert rates are currently nowhere close.

...I hope ABPM makes a bit of a comeback, but it's currently a group of brand new non-elected ppl and crazy ppl that are 100% useless after last week (and began heading that way last year). I think anyone with their eyes open knows that at this point. Kudos for the outgoing BOD for the walkout and attempts to remove the prez. Any stragglers still supporting ABPM at this juncture, despite the recent goings-on, are just doing it out of anti-ABFAS mentality. Nothing more.

So, for better or worse, that leaves ABFAS as the only viable podiatry board.... and it needs improvement. It needs to be more inclusive and attainable. I'd say lose the Foot / RRA distinction as it's already a speciality. Test the whole DPM scope since even those not doing recon need to know it and understand it... but let hospitals sort that out in privileging. Make the cases/diversity log to sit for BC much more reasonable, and the BC should be face-to-face again. Add face-to-face standarized cases and cursory review of candidate hospital/case logs like many MD surgical specialties? The ABFAS BQ exams are likely pretty much fine; people can just study harder... and besides, that'd basically solve itself with better students/residencies.

 

[RollingstonePod]

Pass rates are quite different. ^^
The % of DPM grads who even pass ABFAS BQ or even eventually try to sit for BC ("sit" is the antiquated term... submit online) is much different than ABMS boards. It is significantly lower. That's multi-factorial, but it is nowhere close to ortho, gen surg, any of them in terms of % of residency grads who go on to become cert.

So, let's just...

• Remove the accreditation for all of the bad DPM residencies and reduce/consolidate spots at ones that are salvageable.
• That'd force pod schools to be a bit selective and keep enrollment to reasonable number based on quality residency spots (or knowingly create/worsen residency shortage, which would scare off students... so, either way).
• That would allow for better training and more surgery per young DPM and eventually get ABFAS pass rate to 90 or 95%... like MD surgery boards?

That was easy. It'd actually fix jobs/income as well as boards/respect in the same fell swoop. But we can't say we are like MD boards when residency spots/standards and cert rates are currently nowhere close.

...I hope ABPM makes a bit of a comeback, but it's currently a group of brand new non-elected ppl and crazy ppl that are 100% useless after last week (and began heading that way last year). I think anyone with their eyes open knows that at this point. Kudos for the outgoing BOD for the walkout and attempts to remove the prez. Any stragglers still supporting ABPM at this juncture, despite the recent goings-on, are just doing it out of anti-ABFAS mentality. Nothing more.

So, for better or worse, that leaves ABFAS as the only viable podiatry board.... and it needs improvement. It needs to be more inclusive and attainable. I'd say lose the Foot / RRA distinction as it's already a speciality. Test the whole DPM scope since even those not doing recon need to know it and understand it... but let hospitals sort that out in privileging. Make the cases/diversity log to sit for BC much more reasonable, and the BC should be face-to-face again. Add face-to-face standarized cases and cursory review of candidate hospital/case logs like many MD surgical specialties? The ABFAS BQ exams are likely pretty much fine; people can just study harder... and besides, that'd basically solve itself with better students/residencies.

I agree with most of what you stated and I think your proposed solutions are spot on. I hate to say this, but it’s a fact, the caliber of student that gets accepted to medical school or osteopathic medical school is much higher than most podiatry students. ABFAS has nothing to do with student acceptance at the schools or residency competency. Fix both of those issues, and you’ll see the pass rates mimic that of other ABMS boards.

 

[Shiyuan]

So, for better or worse, that leaves ABFAS as the only viable podiatry board.... and it needs improvement. It needs to be more inclusive and attainable. I'd say lose the Foot / RRA distinction as it's already a speciality. Test the whole DPM scope since even those not doing recon need to know it and understand it... but let hospitals sort that out in privileging. Make the cases/diversity log to sit for BC much more reasonable, and the BC should be face-to-face again. Add face-to-face standarized cases and cursory review of candidate hospital/case logs like many MD surgical specialties? The ABFAS BQ exams are likely pretty much fine; people can just study harder... and besides, that'd basically solve itself with better students/residencies.

Last paragraph 👍🏻 ⭐️⭐️⭐️⭐️⭐️

Fix ABFAS.... then merge both Boards already for the sake of all our sanities 🤪🤪

 

[air bud]

And for the record I was doing 40 cases a year in a rural location and was able to get certified in both foot and rra.

 

[Feli]

I agree with most of what you stated and I think your proposed solutions are spot on. I hate to say this, but it’s a fact, the caliber of student that gets accepted to medical school or osteopathic medical school is much higher than most podiatry students. ABFAS has nothing to do with student acceptance at the schools or residency competency. Fix both of those issues, and you’ll see the pass rates mimic that of other ABMS boards.

Concur... a lot of what I said is responsibility that's mainly on the pod schools, AACPM, CPME, residencies themselves, etc... not the realm or primary duty of ABFAS.

Still, this is a very pivotal time for ABFAS. There is an empty net scenario here (and yeah, there pretty much has been... since forever).

Regardless, DPMs shouldn't be afraid or feel alienated by the best board we have. That is unfortunate. That has to be remedied. The process has to improve.

As we saw last year and this year with all of the commentary, many DPMs do feel left behind. That will allow the 'kill-em-all' mentality to be raised again in the future by anyone with a voice... even if they are unhinged or clearly don't have a better solution. And sure, part of it is a saturation thing, but ABFAS can do their part.

It's much better to improve ABFAS and make it more accessible than to have a sizeable percentage of people continue to fear and attack it. ABFAS is the obvious foundation blocks we DPMs have to work with for an optimal process that will get good overall results, single board, etc. There will always be alt boards in some way shape or form, but there should be channels for more DPMs who finish these 3yr programs - even the lower tier ones - to pass and become board cert by the primary board if they study hard and do cases after training.

So yeah, in an ideal world, we'd raise DPM training - and maybe that will happen incrementally. We can't predict the pass rate in that theoretical bubble, though. Meanwhile, in the present day, we need to play the hand we are dealt and adjust on the fly. If ABFAS just sits in the high castle and looks down on roughly half of residencies/graduates or penalizes those who won't stay in the same crummy job out of residency until 95% of DPMs can pass their current exam format, then they will continue to have the troubles and frustrations which they do. Like anything, the answer is not black or white... it's gray. ABFAS can have a reasonable process for board cert and also do what the org can to promote raising training levels, MAVs, academics, board prep, etc at residencies.

...Now, if y'all will excuse me, I need to go put in some pre- op orders for a couple scope/stab and fusion cases tomorrow that 'm not certified for 10yrs afer residency.

 

[Feli]

And for the record I was doing 40 cases a year in a rural location and was able to get certified in both foot and rra.

Yeah, but your pre/post op notes were on point, you stayed at one job to have the notes + XRs, and they tend to be biased towards really really good looking guys.

 

[Poddy2Hotty]

If you read through the ABFAS case requirements you know exactly what they will ask for. If you are in a crappy pp job you can plan ahead and print/save XR of all your surgical patients and print notes of their post op visits in the global period. Then you don't need to ask your old boss for anything. You are only trapped by yourself.

Another thing is LOG EVERY CASE RIGHT AWAY. DON'T WAIT. Many friends are years behind on logging and feel overwhelmed. You log every case in residency. Keep logging once you graduate...simple as that.

If people want to blame ABFAS for failure to plan they can.

The problem isn't ABFAS its the schools, CPME, AACPM and their greed. I've said many times everything needs to be cut in half (schools, residencies) and residency case requirements need to be doubled. SELECTIVITY NEEDS TO INCREASE in order for the ABFAS CERTIFICATION RATE TO INCREASE. Just because you scraped through school and did a nail jail residency doesn't mean you should pass. Ortho is so selective from the beginning they can afford to have a less strict certification process. The ABFAS requirements are published and straight forward. DO GOOD NOTES, DO GOOD WORK, DOCUMENT WHAT IS REQUIRED (Get those pre-op XR and post-op WB XR, etc) and its fairly straight forward. You know exactly what they will request and can have everything ready to go ahead of time if you prepare.

Yes the ABFAS cert process could be improved with a lot of things being overly tedious and time-consuming, but for now this is the best we have as a profession. The anger is directed in the wrong direction. ABFAS is not failing anyone, the training system as a whole is.