ABFAS and ABPM CAQ

[DYK343]

Sample letter ABFAS sent me today meant to be given to hospital staff privileging department. They are not happy about ABPM's CAQ in surgery.


DATE



Dear [INSERT CHAIR NAME(S)]:



As the committee responsible for granting surgical privileges to physicians, I know that you consider a variety of factors to ensure a strong professional staff and positive patient outcomes. Given that board certification is one of the many factors you weigh, a recent development in the podiatric field merits your attention as it could present a potential risk to patient safety.



The American Podiatric Medical Association (APMA) and Council on Podiatric Medical Education (CPME) have long recognized that there are two distinct specialties in which to be board certified: medicine and surgery.



Recognized boards require graduation from a CPME-accredited college of podiatric medical education, completion of a CPME-approved, three-year residency, and completion of a comprehensive examination process. CPME recognizes the American Board of Podiatric Medicine (ABPM) as the certifying board for non-surgical podiatric medicine, including orthotics, dermatology and biomechanics of the foot and ankle.



Importantly, the American Board of Foot and Ankle Surgery (ABFAS) is the only certifying board recognized by CPME for the specialty area of podiatric surgery.



Over 10,000 podiatrists, myself included, have earned ABFAS Board Certification by demonstrating specialized competency and skill in foot and ankle surgery. ABFAS Board Certification is a rigorous, two-step process, which includes significant case review to ensure a thorough level of clinical experience and surgical skill has been achieved prior to granting surgical Board Certification. ABFAS is the only certification board in podiatry that undertakes this review of a surgeon’s skill.



Recently, the American Board of Podiatric Medicine (ABPM) opened applications for what it calls a “Certificate of Added Qualification (CAQ) in Podiatric Surgery,” outside of the profession’s traditional certification process. Several leading podiatric organizations – including the American College of Foot and Ankle Surgeons, Council on Podiatric Medical Education, and the American Podiatric Medical Association – have raised serious concerns about ABPM’s launch of the new CAQ and the potential confusion it may cause among patients and hospitals.



To quote directly from APMA’s August 12, 2022 statement on the issue (with emphasis added):



“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 board 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.”



I am invested in the success of this hospital and care deeply about the patients we serve. That is why I believe board certification should carry significant weight when granting surgical privileges. From my perspective, I respectfully submit that it would be in the best interests of patients for the hospital to require ABFAS certification for podiatric surgeons, though I recognize that the hospital must make its own decision based upon relevant factors. With that in mind, it is important for patients, providers, the broader medical community, and especially the members of this committee to understand the differences between ABFAS Board Certification in foot and ankle surgery and ABPM’s unrecognized CAQ in podiatric surgery. The two are not comparable credentials.



ABFAS has posted additional information online about the difference between ABFAS Board Certification and ABPM’s CAQ. I encourage you to review this page and contact me directly if you have any questions or concerns about this matter.



Sincerely,



[INSERT NAME, CREDENTIALS]

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Members don't see this ad.

 

[DYK343]

seems like ABFAS is scared and trying to gatekeep further. podiatrists trying to hold other podiatrists down. typical.

go get 'em @diabeticfootdr

also when they say over 10,000 podiatrists have earned the ABFAS certification... how many was grandfathered in? how many could pass the exam the current residents have to take? LOL

If you were going to get operated on by a DPM would you want someone who passed ABFAS doing the surgery?

Or someone who wasnt able to pass the exam because they failed the test and got a CAQ instead?

 

[heybrother]

If you were going to get operated on by a DPM would you want someone who passed ABFAS doing the surgery?

Or someone who wasnt able to pass the exam because they failed the test and got a CAQ instead?

Did they do a fellowship?

 

[dtrack22]

I would reply to ABFAS and ask why as the only podiatrist at my hospital I would want to restrict my own privileges? But they wouldn’t respond. At least not with anything intelligent

 

[dtrack22]

If you were going to get operated on by a DPM would you want someone who passed ABFAS doing the surgery?

I would operate on myself if I could and I’m not ABFAS certified at the moment.

 

[DYK343]

I would operate on myself if I could and I’m not ABFAS certified at the moment.

I know someone who removed their own neuroma in their office afterhours.

 

[DYK343]

I’ve scrubbed cases during residency with “abfas qualified” surgeons who were terrible so it depends on more than that

OK. But qualified is not certified. So you didnt answer the question.

Would you rather have someone certified with CAQ or certified by ABFAS do your surgery? That was the question.

And yes, just becuase youre qualified doesnt mean youre a good or bad surgeon. Everyone who is certified was at one point qualified.

Personally if I was to go under the knife I would want someone who passed ABFAS doing my surgery. Its hard to be a hack and pass the board exam. It can be done but much more likely to have someone competant doing it with ABFAS cert over CAQ.

 

[air bud]

If you were going to get operated on by a DPM would you want someone who passed ABFAS doing the surgery?

Or someone who wasnt able to pass the exam because they failed the test and got a CAQ instead?

Ah but there's the rub. You are assuming they couldn't pass ABFAS and instead chose ABPM....

 

[heybrother]

Foot is meaningless. All the dinosaurs in my town have foot. You can basically get it doing Austins all day.

 

[DYK343]

Ah but there's the rub. You are assuming they couldn't pass ABFAS and instead chose ABPM....

ABFAS is the harder of the two boards.

Always exceptions but those who dont pass ABFAS go for ABPM for hospital privileges. Its much easier to get ABPM.

If I was on vacation and sustained an injury that couldnt wait and two DPM surgeons showed up. One ABFAS cert one ABPM cert with CAQ I would personally go for the ABFAS surgeon to do my case because I would have more trust in the ABFAS cert process.

Podiatry accepts anyone with a pulse and a paycheck into school. There is a reason a lot of people cant pass ABFAS. Its a hard exam, has its problems, and is confusing on the pass/fail for case reviews. But if you do the right thing, have good xrays/documentation, and manage complications like they should be managed then you should pass the exam.

- - -

And for the record no I am not turning this letter into my hospital staff to be a gatekeeper. I keep to myself around the hospital and dont go nosing around into other doctors business. I am not on the credentialing committee and have no desire to be apart of credentialing.

 

[AttackNME]

What is the risk in giving ABPM cert podiatrists surgical priviledges? They all have had the 3 years training. I mean how prevalent is the “harm” in these podiatrists. They’re not routinely doing hindfoot ankle or trauma. Or are they?

 

[LossToFollowUp]

Why not just have ABPM certify non-surgical podiatrists and ABFAS certify surgical podiatrists? Do our leaders really believe every single podiatrist currently and graduating want to be surgeons? I know plenty of colleagues that have no intention of ever being in the OR.

 

[Feli]

Why not just have ABPM certify non-surgical podiatrists and ABFAS certify surgical podiatrists? Do our leaders really believe every single podiatrist currently and graduating want to be surgeons? I know plenty of colleagues that have no intention of ever being in the OR.

That is the way it always was...

The people who would take ABPOPPM (now ABPM) and wanted to do non-op (office, injects, wounds, orthotics, etc) were not a problem.

The people who wanted to study and pass ABFAS (was ABPS) and wanted to do OR as well as non-op weren't a problem.

A few DPMs would take and pass both boards.

The problem now (and always) lies in the middle-ground DPMs who are trying to do OR surgery with low quality or no training, can't pass the surgery boards, and they keep doing that stuff anyways.That is detrimental to the patients, the profession rep, etc. To be fair, you even get a few that did get through ABFAS that struggle... and that's up to the hospitals and local colleagues to handle, but the rate of incompetence is much higher without appropriate boards. It's the same in plastics, ortho, anything... the vast majority of the stories you'll read with many malpractice cases, horrible outcomes, lack of sterility, etc will be non-board cert (or a fake/disguise board).

The ABPM CAQ is an intentional attempt to blur the lines and that's no secret from the responses, but it probably won't last long.
I don't think our leaders think everyone wants to be a surgeon, no... but you had better believe many of them want to be surgeons and can't pass surgical boards, so they're trying to help themselves and appealing to others like them with CAQ.

 

[AttackNME]

I know of an ABPM DPM doing rearfoot cases.

External fixation for charcot cases without any internal fixation. Bound to fail once ambulatory again.

Also doing Chopart amps/ankle disarticulations and applying frames. Claiming to be doing limb salvage when a BKA would provide the best functional outcome. A prostetic limb would make the patient much more ambulatory and prolong the life of the patient over a non functional chopart.

Both of those cases would not have passed ABFAS cert process.

One could argue these limb salvage cases are doomed to fail anyway since those patients are going to be dead in 5-10 years, and most are already disabled or unable to work. Now elective cases where these patients are expecting to go back to work, a bad outcome would be much more life-changing. I think this needs to be distinguished. Example is the survivorship of a total ankle is better than the life expectancy of a patient with DFUs. Who are the surgeons doing total ankles, bunions, and elective flatfoot? Where are majority of the bad outcomes coming from? Where’s the data? What’s the point of all this gate keeping if it’s possible that ABFAS needs to do better gatekeeping within themselves?

 

[Shiyuan]

 

[ExperiencedDPM]

If abfas wants to truly protect the public they should distinguish the podiatrists who did 1 year residencies who are “abfas” certified vs the new generation of podiatrists who are abfas certified through a more rigorous process. Just my opinion

I’m not sure the process is more rigorous now. For many, even getting a one year residency was an accomplishment. But the actual exam has never been an easy process.

I am well trained and I am not “grandfathered” in, but I believe I had to send in 75-100 cases for review and they chose about 25 for detailed review. And that preceded computerized hospital records and digital radiographs. Just gathering op reports, path reports, films, etc was a crazy amount of work.

Candidates had to all fly to Chicago to take the qualifying exam and after a few years of practice candidates had to send in the cases which were always diversified. Then they candidate had to fly to Chicago and take the written certifying exam and two days of oral exams.

So although today’s training is longer and more often than not better, I would argue that the test process was not easier in the “old” days. I have been involved with that process in the past and recent present.

 

[DYK343]

One could argue these limb salvage cases are doomed to fail anyway since those patients are going to be dead in 5-10 years, and most are already disabled or unable to work. Now elective cases where these patients are expecting to go back to work, a bad outcome would be much more life-changing. I think this needs to be distinguished. Example is the survivorship of a total ankle is better than the life expectancy of a patient with DFUs. Who are the surgeons doing total ankles, bunions, and elective flatfoot? Where are majority of the bad outcomes coming from? Where’s the data? What’s the point of all this gate keeping if it’s possible that ABFAS needs to do better gatekeeping within themselves?

I have a question for you.

If you were injured and needed an emergency surgery and two DPMs showed up. You knew nothing of the two other than one has a CAQ and one has ABFAS.

Which one would you chose?


- - -

ABFAS randomly selects 10 foot and 10 RRA cases for certification. There is no pick and chose cases by provider. Any and all cases you perform must be uploaded (they do an randon date audit in attempt to catch people not logging a bad outcome case). If you botch the cases you fail. If you did the right thing you pass. Its not a perfect system but its a gatekeeping system.

 

[msion]

The problem with ABFAS is that it’s not a fair process. And it always make me wonder if you pay twice then you magically pass, then there is definitely something going on.
ABPM is definitely not better, but the CAQ can have some value in getting people privileged and use their training.
And with the current state of podiatry and medicine in general, maybe one won’t be interested in doing surgeries after practicing for 7 years. And in my situation where I am bringing lots of cases to the hospitals, are they really going to kick me out if I am not ABFAS certified? I doubt that.
Whether you are ABFAS or ABPM certified, a great majority of the work will still be diabetic pus for hospital work. That's where the demand is.
If one decides we all must be ABFAS certified with fellowship training for an I&D (which ironically may happen in our ridiculous profession), then I will just quit and write emails to prehealth clubs in the schools to let them all avoid podiatry.

 

[Feli]

If abfas wants to truly protect the public they should distinguish the podiatrists who did 1 year residencies who are “abfas” certified vs the new generation of podiatrists who are abfas certified through a more rigorous process. Just my opinion

I would agree with @ExperiencedDPM that the ABFAS process isn't any easier now... there are just a lot higher % of DPM grads taking ABFAS exams (since all residencies are 3yrs and all residencies "surgical").

It could probably be argued that the pass rates are actually higher now (because it was only the top half/third/quarter getting surgical residency and trying for ABFAS in the past). Historic pass rates would have been much worse with the lower ranked students taking it... but they didn't get a surgical residency and logically didn't try it.

...These days, it's nearly 100% of DPM residents doing the ABFAS in-training exams, vast majority try for ABFAS board qual, good number go for board cert ABFAS. The bottom guy/girl in the class got a 3yr and could pass it. No, the overall pass rates aren't high, but it's not only a fraction attempting the test anymore. It's everyone. ABFAS isn't in charge of podiatry school admissions, residency quality or lack of, how people study... they just try to make tests to assess the standards of care in F&A surgery and eval cases DPMs perform for proficiency.

 

[Adam Smasher]

Here's my $0.02

Due to COVID/procrastination, I am still in the process of applying for ABFAS certification. As noted, it's a tedious process. Tried once, failed. Some of the criticisms of my work were legit (one 1st mtp nonunion that I hadn't yet revised at the time of case submission--she's healed now) while many were nitpicky. I'm in the process of re-trying. I've had many satisfied patients, helped a lot of people, hopefully the board recognizes that.

Meanwhile ABPM certification has gotten me everything I need professionally, I'm on insurance panels and have full podiatry privileges at hospitals where I do cases. I have no intention of applying for the CAQ because ultimately no one will care. No one outside of our tiny insular world of podiatry cares about the differences between ABPM and ABFAS because to them they're all just podiatry boards.

So why bother going through the headache of applying for ABFAS? Pride? I guess so. That and the concern that it will bite me in the butt some day if I don't get certified while I have the chance.

 

[de Ribas]

Here's my $0.02

Due to COVID/procrastination, I am still in the process of applying for ABFAS certification. As noted, it's a tedious process. Tried once, failed. Some of the criticisms of my work were legit (one 1st mtp nonunion that I hadn't yet revised at the time of case submission--she's healed now) while many were nitpicky. I'm in the process of re-trying. I've had many satisfied patients, helped a lot of people, hopefully the board recognizes that.

Meanwhile ABPM certification has gotten me everything I need professionally, I'm on insurance panels and have full podiatry privileges at hospitals where I do cases. I have no intention of applying for the CAQ because ultimately no one will care. No one outside of our tiny insular world of podiatry cares about the differences between ABPM and ABFAS because to them they're all just podiatry boards.

So why bother going through the headache of applying for ABFAS? Pride? I guess so. That and the concern that it will bite me in the butt some day if I don't get certified while I have the chance.

So you can fail ABFAS certification if you got one non-union case?

 

[dtrack22]

Some of the criticisms of my work were legit (one 1st mtp nonunion that I hadn't yet revised at the time of case submission--she's healed now) while many were nitpicky.

This is still an issue with ABFAS and an issue with no more oral case review like Ortho does. I mean I get losing a point or two if patient selection or some construct on your part was the reason for non union. But you shouldn’t lose a single point for a non union assuming your documentation shows that you recognized it and worked it up/treated it correctly. Non unions happen, and they can happen with an excellent surgery and a compliant patient. It’s a well documented complication that happens in a % of bone surgery. But I’ve seen dozens of people who have lost points on case review for X-rays the grader doesn’t like, or an asymptomatic non union, or a non union that was caught and managed appropriately. It’s a really really dumb process.

As someone who has privileges with my current ABPM cert, and who has good enough outcomes that the hospital continues to let me do cases I have privileges for, why should I NEED ABFAS to practice? How does passing the ABFAS Case review magically make me a better podiatrist?

 

[Adam Smasher]

So you can fail ABFAS certification if you got one non-union case?

That was one specific example.

I did a lapidus and tailors bunion. Implants looked fine on the fluoro which I didn't save. Lapidus healed magnificently but I airballed one of my screws on the tailors. 5th met healed anyway, but they didn't like that screw. So from now on I'm saving my fluoros. Extra scanning but at least now on my immediate post-ops you can see that my implants all are where I intend them to be.

I had a met adductus/hallux varus patient that I did 1st mtp tightrope + weil of 2nd and 3rd in addition to some hammertoes. Her XR looked great but I caught flak for not "biomechanically evaluating" the lesser met osteotomies, which I guess means palpating the bone.

I did a bunion + weil. Probably my quickest return-to-work I ever had, she was feeling that good. However, at final f/u, the patient stood on the XR platform with her toes sort of extended because she was kind of extra. The reviewer really savaged me on that one. "You didn't address the loss of hallux purchase!!!"

Anyway, lesson learned, no matter how busy you are working your clinic, be conscientious about your charting, because if I took the extra 10 sec to mention these issues it might have saved me some points. And remembe, "good enough" isn't good enough!

 

[de Ribas]

That was one specific example.

I did a lapidus and tailors bunion. Implants looked fine on the fluoro which I didn't save. Lapidus healed magnificently but I airballed one of my screws on the tailors. 5th met healed anyway, but they didn't like that screw. So from now on I'm saving my fluoros. Extra scanning but at least now on my immediate post-ops you can see that my implants all are where I intend them to be.

I had a met adductus/hallux varus patient that I did 1st mtp tightrope + weil of 2nd and 3rd in addition to some hammertoes. Her XR looked great but I caught flak for not "biomechanically evaluating" the lesser met osteotomies, which I guess means palpating the bone.

I did a bunion + weil. Probably my quickest return-to-work I ever had, she was feeling that good. However, at final f/u, the patient stood on the XR platform with her toes sort of extended because she was kind of extra. The reviewer really savaged me on that one. "You didn't address the loss of hallux purchase!!!"

Anyway, lesson learned, no matter how busy you are working your clinic, be conscientious about your charting, because if I took the extra 10 sec to mention these issues it might have saved me some points. And remembe, "good enough" isn't good enough!

Looks like there is a lot of subjectivity involved within certification/grading process. It does not equal to being rigorous. Some people even though they are great surgeons nay just get unlucky due to what case and who grades the case based on their subjective opinion. So this process may let mediocre get certified and great surgeons fail.

 

[Feli]

...As someone who has privileges with my current ABPM cert, and who has good enough outcomes that the hospital continues to let me do cases I have privileges for, why should I NEED ABFAS to practice? How does passing the ABFAS Case review magically make me a better podiatrist?

...So why bother going through the headache of applying for ABFAS? Pride? I guess so. That and the concern that it will bite me in the butt some day if I don't get certified while I have the chance.

Yah, I don't think it makes one a better surgeon. The training and the outcomes did that. The studying for BQ never hurt anyone, though.
Hospitals and hiring ppl and local colleagues are like anyone... trust but verify. ABFAS is the verify.

I am in the same boat: have passed all didactic ABFAS stuff for Foot and RRA, did cases, failed BC on some questionable and some legit criticisms of XRs or mainly pre-op paperwork... now re-doing. I have other friends who have passed BC first try and others who couldn't ever even pass the BQ.

... As to benefits, it just shows proficiency to be ABFAS cert. It is the most appropriate board for today's residencies (and many of the past ones also). It's definitely a signaling to other DPMs (and ortho/msg/hospitals that have a DPM even loosely in charge of hiring and decision making). Any DPM essentially knows that someone without ABFAS BQ/BC failed it and/or has lesser training and lesser capability. A lot of hospitals, esp govt, will put you on a higher salary if you have ABFAS and the associated abilities. It is often a flat-out job requirement, it has been an interview question to me and/or a selling point I've used for every facility I've ever been on staff or employed at.

Another way to look at it is as a simple marketing tool. We have all stated again that the profession is saturated in many places, and that might get worse with more schools graduating soon. ABFAS Foot BC puts your rarity into the top half or fewer of DPMs, and ABFAS RRA BC puts you into top <10%. Plenty of CVs have been tossed from consideration for various reasons, and anyone can connect the dots.

Whether any place will actually let you go or reduce privileges or freeze pay raises or anything if you don't finish ABFAS BC is regional. It will definitely never hurt you, and you can drop ABPM once you get ABFAS. I think it is crazy for every modern grad to not at least do their very best to finish ABFAS Foot. Most hospitals have figured out by now that there's a competency and compensation difference between DPMs with surgical training and a non-op one without surgical residency. Some are starting to figure out ABFAS vs non; that's pretty clear by all of the ones that have bylaws require ABFAS BQ and ABFAS BC within 5yrs or some reasonable span to have OR privileges. And again, it all depends on what they are hiring for or how their politics run, but it's never going to hurt you. Hospital politics change ALL THE TIME.

At the end of the day, the obvious answer is that it just makes sense to seek board cert in the most appropriate board for one's specialty. That is ABFAS for any DPM doing an appreciable amount of surgery. @CutsWithFury made a good point to never leave any loopholes open for your privileges to be limited or for them to pick another job candidate over you. So, you might be ok without ABFAS cert at your current gig, but BQ won't last forever... and will ABPM get you your next job or retain your OR privi indefinitely? I don't want to find out or feel trapped at one job/hospital, and I guess that's the way I think of it also.

 

[Adam Smasher]

My biggest objection to ABFAS is not that they're subjective or that they're unforgiving but that they rely almost entirely on our before/after radiographs, when we KNOW from numerous studies that radiographic outcomes do not correlate with patient satisfaction or patient function.

 

[Feli]

My biggest objection to ABFAS is not that they're subjective or that they're unforgiving but that they rely almost entirely on our before/after radiographs, when we KNOW from numerous studies that radiographic outcomes do not correlate with patient satisfaction or patient function.

Correct... but ortho boards go on pre/post XRs, plastics goes on pre/post pictures, etc.

There really is no objective ways to do it outside didactics and expert reviews. I agree with @dtrack22 that it would be optimal to still have face-to-face review. For sure.

Any patient stuff is far too subjective (although it absolutely matters). There are plenty of pts with near-perfect XRs who don't like their surgeon since he rushed the visits... and plenty of crazy toe XR ppl who would go to war for the podiatrist who did it, but it's just not an objective way to eval them. Some docs are hand-holders and some are master technicians and all should aim for a bit of both, but only one side shows up on angles and outcomes.

Like I said, I failed mostly for not doing good pre-op notes (cases were sent to me by internal or external colleagues already worked up and already did conservative cares), so imagine how happy I am to be repeating the process

 

[AttackNME]

Sounds like all of this could’ve been avoided if the ABFAS certifying process can be improved. Wonder if they’re working on this already. Anyone got insight on this?

 

[msion]

So, you might be ok without ABFAS cert at your current gig, but BQ won't last forever... and will ABPM get you your next job or retain your privi indefinitely? I don't want to find out or feel trapped at one job/hospital, and I guess that's the way I think of it also.

If that’s the case then the profession and its leaders are failing us. We really shouldn’t accept the current status quo with ABFAS having an unfair review process yet still dominates the way we get to practice.
These issues have been present for a long time, even starting with our own APMLE boards. Blurry images, vague questions… but there is no improvement because these organizations are not being challenged.
Some 5-10% dorsal lucency of the austin osteotomy despite lack of symptoms? Nope you lose the point. Just because the reviewers have this power to do so. If they think the screw head is too big then it’s too big.
I once talked to a guy on the board of ABFAS at ACFAS regarding the above concerns. He shrugged his shoulders and just said “boards are supposed to be hard” and walked away. I don’t think they care, and they don’t bother to change.

 

[Feli]

Sounds like all of this could’ve been avoided if the ABFAS certifying process can be improved. Wonder if they’re working on this already. Anyone got insight on this?

Yes, this is the key ^^^

The training must improve in schools, it must improve a TON at many "surgical" residencies, but ABFAS can improve also. 100%.

The wrong answer is to make a backdoor simple route to skirt real eval of training and competence and outcomes. That will hurt the whole profession in many ways.

I have no personal connects with ABFAS anymore aside from a few question reviewers and residency site visit ppl, but you can surely bet the CAQ nonsense made ABFAS take a good look at their overall processes and goals.

 

[Shiyuan]

ABFAS and ABPM merge... problem solved!? 🤔😬🦶🏻

 

[msion]

ABFAS and ABPM merge... problem solved!? 🤔😬🦶🏻

Doubt that. If this profession were to die off and we end up with only two podiatrists in this country, you bet one is ABFAS certified and the other is with ABPM, and both will still have to pay their APMA/ACFAS memberships and signed up for PM News.

 

[Boba Foot]

Sample letter ABFAS sent me today meant to be given to hospital staff privileging department. They are not happy about ABPM's CAQ in surgery.


DATE



Dear [INSERT CHAIR NAME(S)]:



As the committee responsible for granting surgical privileges to physicians, I know that you consider a variety of factors to ensure a strong professional staff and positive patient outcomes. Given that board certification is one of the many factors you weigh, a recent development in the podiatric field merits your attention as it could present a potential risk to patient safety.



The American Podiatric Medical Association (APMA) and Council on Podiatric Medical Education (CPME) have long recognized that there are two distinct specialties in which to be board certified: medicine and surgery.



Recognized boards require graduation from a CPME-accredited college of podiatric medical education, completion of a CPME-approved, three-year residency, and completion of a comprehensive examination process. CPME recognizes the American Board of Podiatric Medicine (ABPM) as the certifying board for non-surgical podiatric medicine, including orthotics, dermatology and biomechanics of the foot and ankle.



Importantly, the American Board of Foot and Ankle Surgery (ABFAS) is the only certifying board recognized by CPME for the specialty area of podiatric surgery.



Over 10,000 podiatrists, myself included, have earned ABFAS Board Certification by demonstrating specialized competency and skill in foot and ankle surgery. ABFAS Board Certification is a rigorous, two-step process, which includes significant case review to ensure a thorough level of clinical experience and surgical skill has been achieved prior to granting surgical Board Certification. ABFAS is the only certification board in podiatry that undertakes this review of a surgeon’s skill.



Recently, the American Board of Podiatric Medicine (ABPM) opened applications for what it calls a “Certificate of Added Qualification (CAQ) in Podiatric Surgery,” outside of the profession’s traditional certification process. Several leading podiatric organizations – including the American College of Foot and Ankle Surgeons, Council on Podiatric Medical Education, and the American Podiatric Medical Association – have raised serious concerns about ABPM’s launch of the new CAQ and the potential confusion it may cause among patients and hospitals.



To quote directly from APMA’s August 12, 2022 statement on the issue (with emphasis added):



“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 board 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.”



I am invested in the success of this hospital and care deeply about the patients we serve. That is why I believe board certification should carry significant weight when granting surgical privileges. From my perspective, I respectfully submit that it would be in the best interests of patients for the hospital to require ABFAS certification for podiatric surgeons, though I recognize that the hospital must make its own decision based upon relevant factors. With that in mind, it is important for patients, providers, the broader medical community, and especially the members of this committee to understand the differences between ABFAS Board Certification in foot and ankle surgery and ABPM’s unrecognized CAQ in podiatric surgery. The two are not comparable credentials.



ABFAS has posted additional information online about the difference between ABFAS Board Certification and ABPM’s CAQ. I encourage you to review this page and contact me directly if you have any questions or concerns about this matter.



Sincerely,



[INSERT NAME, CREDENTIALS]

This sounds as desperate as Trump selling NFT trading cards. Sad.

 

[Boba Foot]

If I was on vacation and sustained an injury that couldnt wait and two DPM surgeons showed up. One ABFAS cert one ABPM cert with CAQ

Podiatry accepts anyone with a pulse and a paycheck into school

Tell me you’d secretly call ortho, without telling me you’d secretly call ortho.

The argument between these two boards is becoming futile. Average Joe doesn’t know **** between ABFAS and ABPM, just like they don’t know **** about a MedStar/Penn Presby residency vs. a New York residency. These are all semantics that are being beat to death on this board that average patients or even referring docs don’t know/care about.

One of the bigger frustrations I’ve had recently was having an Endo group I didn’t know at all redirecting one of my patients to ortho on a simple stress fracture. I think the bigger fight right now is still promoting what we are able to do to other specialties versus gatekeeping each other based on boards with abysmally low pass rates.

 

[DPM TRUTH]

Hello collegues, hope everyone is having a safe holiday season.

Everytime the ABFAS releases one of these (hilariously desperate) letters, I must respond. Everytime its the same thing.

Instead of wasting your time ABFAS gurus, try to stick on task and answer the following questions.

First question ABFAS gurus, how did you get your certificate? Please choose A, B, or C.

A.) They have a foot and ankle certificate because they told each other those are the rules. They never took a test or touched an ankle in their life. I.E. grandfathered in with a foot and ankle certificate.

B.) They have a foot surgery certificate via "the alternative pathway" they achieved from knowing the right people. I.E. never did a surgical residency but sat for the surgery boards.

C.) They legitly passed without bending any rules. The way it should be.

And they wanna say the ABPM CAQ is confusing the public? They have been confusing the profession and public with A, B, and C above for 20+ years and "now care"? If they cared, cohorts A and B would get a HUGE ASTERICK next to their certificate allowing the public to understand they might not have completed a surgical residency. The abfas can't do that though, it would embarrass their "members,". Who cares about public safety again?

When the ABFAS has time to clean up the above mess (within their own establishment) they can start worrying about the ABPM CAQ.

I would rather have a dpm with the abpm caq take care of a families surgical foot issue vs. Someone who was grandfathered in by abfas and NEVER completed a surgical residency!!! At least we know everyone with the ABPM. CAQ completed a SURGICAL RESIDENCY. Yes some might be "subpar" but it's better than NEVER completing one at all, like the grandfathered in ABFAS members are "cool with".

The lack of a
answers from the abfas gurus/leadership to questions #1 make the latest letter as worthless as their previous letters to credentialing. More and more people see it for what it is, separate rules bases on who you knew when it comes to the mightly abfas. Period.

So again ABFAS, why no where on the ABFAS website do they inform the public or other specialities about how the rules for group A and B were diffrent (with respect to no surgical residency or ankle work) Clean this up first ABFAS, then your silly letters will make a little more sense and not contradict themselves each time.

CPME, care to weigh in on why you continue to allow this misleading practice for more than 20+ years? Maybe because most in leadership were grandfathered in and don't wanna touch this with a 20ft poll?

Patients are not happy when they find out their ABFAS surgeon never completed a surgical residency. Especially when things go wrong.

 

[Sweatshirt]

ABFAS is the biggest scam organization on the planet and I can't wait until all you boomer gatekeeper podiatrists retire. Nobody outside the people on this forum care which board certification you have. ABFAS can feel their power and credibility tanking every passing day. This letter is a clear and desperate power play. I hope ABFAS continues to desperately flail around as it tries to retain power until it eventually dies off

 

[DYK343]

Tell me you’d secretly call ortho, without telling me you’d secretly call ortho.

If a 3rd person walked in and was F&A ortho I would pick that one for my case.

 

[DYK343]

Hello collegues, hope everyone is having a safe holiday season.

Everytime the ABFAS releases one of these (hilariously desperate) letters, I must respond. Everytime its the same thing.

Instead of wasting your time ABFAS gurus, try to stick on task and answer the following questions.

First question ABFAS gurus, how did you get your certificate? Please choose A, B, or C.

A.) They have a foot and ankle certificate because they told each other those are the rules. They never took a test or touched an ankle in their life. I.E. grandfathered in with a foot and ankle certificate.

B.) They have a foot surgery certificate via "the alternative pathway" they achieved from knowing the right people. I.E. never did a surgical residency but sat for the surgery boards.

C.) They legitly passed without bending any rules. The way it should be.

And they wanna say the ABPM CAQ is confusing the public? They have been confusing the profession and public with A, B, and C above for 20+ years and "now care"? If they cared, cohorts A and B would get a HUGE ASTERICK next to their certificate allowing the public to understand they might not have completed a surgical residency. The abfas can't do that though, it would embarrass their "members,". Who cares about public safety again?

When the ABFAS has time to clean up the above mess (within their own establishment) they can start worrying about the ABPM CAQ.

I would rather have a dpm with the abpm caq take care of a families surgical foot issue vs. Someone who was grandfathered in by abfas and NEVER completed a surgical residency!!! At least we know everyone with the ABPM. CAQ completed a SURGICAL RESIDENCY. Yes some might be "subpar" but it's better than NEVER completing one at all, like the grandfathered in ABFAS members are "cool with".

The lack of a
answers from the abfas gurus/leadership to questions #1 make the latest letter as worthless as their previous letters to credentialing. More and more people see it for what it is, separate rules bases on who you knew when it comes to the mightly abfas. Period.

So again ABFAS, why no where on the ABFAS website do they inform the public or other specialities about how the rules for group A and B were diffrent (with respect to no surgical residency or ankle work) Clean this up first ABFAS, then your silly letters will make a little more sense and not contradict themselves each time.

CPME, care to weigh in on why you continue to allow this misleading practice for more than 20+ years? Maybe because most in leadership were grandfathered in and don't wanna touch this with a 20ft poll?

Patients are not happy when they find out their ABFAS surgeon never completed a surgical residency. Especially when things go wrong.

Totally agree. I am curious how many DPMs that are practicing never did a residency. They are getting closer to retirment. 10-15 years this problem will be more or less done with.

 

[DPM TRUTH]

Hi Dyk343,

Totally agree with you that this problem should be history in about 15-20 years, when all the grandfathered in/"alternative pathway" to foot surgery "abfas diplomats" retire from the profession. Then everyone with the abfas certificate played by THE SAME RULES with zero confusion.

So ABFAS until the above time, prob 20 some years away, please stop using "public safety/confusion" card in your form letters. There is nothing more confusing than figuring out if your diplomats fit into A, B, or C. I have been dealing with this for 25+ years as division chief and has made credentialing a nightmare.

 

[air bud]

This sounds as desperate as Trump selling NFT trading cards. Sad.

4x....

 

[air bud]

Here's my $0.02

Due to COVID/procrastination, I am still in the process of applying for ABFAS certification. As noted, it's a tedious process. Tried once, failed. Some of the criticisms of my work were legit (one 1st mtp nonunion that I hadn't yet revised at the time of case submission--she's healed now) while many were nitpicky. I'm in the process of re-trying. I've had many satisfied patients, helped a lot of people, hopefully the board recognizes that.

Meanwhile ABPM certification has gotten me everything I need professionally, I'm on insurance panels and have full podiatry privileges at hospitals where I do cases. I have no intention of applying for the CAQ because ultimately no one will care. No one outside of our tiny insular world of podiatry cares about the differences between ABPM and ABFAS because to them they're all just podiatry boards.

So why bother going through the headache of applying for ABFAS? Pride? I guess so. That and the concern that it will bite me in the butt some day if I don't get certified while I have the chance.

Because life has a funny way of throwing your curve balls. So be prepared for change with ABFAS cert.

 

[Shiyuan]

ABFAS is the biggest scam organization on the planet and I can't wait until all you boomer gatekeeper podiatrists retire. Nobody outside the people on this forum care which board certification you have. ABFAS can feel their power and credibility tanking every passing day. This letter is a clear and desperate power play. I hope ABFAS continues to desperately flail around as it tries to retain power until it eventually dies off

100%. Not one MD/DO doc or NP/PA (70+ Providers) in my group know or care the difference. “You’re Board Certified? Nice!”.

Only other DPMs care... So by default I don’t care. Choose whichever Board you want and ride the wave.

 

[DYK343]

100%. Not one MD/DO doc or NP/PA (70+ Providers) in my group know or care the difference. “You’re Board Certified? Nice!”.

Only other DPMs care... So by default I don’t care. Choose whichever Board you want and ride the wave.

Some hospitals actually do care.

Hospital I joined wants ABFAS certified (not qualified) and didnt interview anyone that didnt have ABFAS. Ortho/podiatry was not involved in this at least locally. Im sure there was ortho/podiatry influence at a higher level. Its a large hospital system and its what they want for their candidates (in additon to 3+ years real world experience).

 

[air bud]

Hello collegues, hope everyone is having a safe holiday season.

Everytime the ABFAS releases one of these (hilariously desperate) letters, I must respond. Everytime its the same thing.

Instead of wasting your time ABFAS gurus, try to stick on task and answer the following questions.

First question ABFAS gurus, how did you get your certificate? Please choose A, B, or C.

A.) They have a foot and ankle certificate because they told each other those are the rules. They never took a test or touched an ankle in their life. I.E. grandfathered in with a foot and ankle certificate.

B.) They have a foot surgery certificate via "the alternative pathway" they achieved from knowing the right people. I.E. never did a surgical residency but sat for the surgery boards.

C.) They legitly passed without bending any rules. The way it should be.

And they wanna say the ABPM CAQ is confusing the public? They have been confusing the profession and public with A, B, and C above for 20+ years and "now care"? If they cared, cohorts A and B would get a HUGE ASTERICK next to their certificate allowing the public to understand they might not have completed a surgical residency. The abfas can't do that though, it would embarrass their "members,". Who cares about public safety again?

When the ABFAS has time to clean up the above mess (within their own establishment) they can start worrying about the ABPM CAQ.

I would rather have a dpm with the abpm caq take care of a families surgical foot issue vs. Someone who was grandfathered in by abfas and NEVER completed a surgical residency!!! At least we know everyone with the ABPM. CAQ completed a SURGICAL RESIDENCY. Yes some might be "subpar" but it's better than NEVER completing one at all, like the grandfathered in ABFAS members are "cool with".

The lack of a
answers from the abfas gurus/leadership to questions #1 make the latest letter as worthless as their previous letters to credentialing. More and more people see it for what it is, separate rules bases on who you knew when it comes to the mightly abfas. Period.

So again ABFAS, why no where on the ABFAS website do they inform the public or other specialities about how the rules for group A and B were diffrent (with respect to no surgical residency or ankle work) Clean this up first ABFAS, then your silly letters will make a little more sense and not contradict themselves each time.

CPME, care to weigh in on why you continue to allow this misleading practice for more than 20+ years? Maybe because most in leadership were grandfathered in and don't wanna touch this with a 20ft poll?

Patients are not happy when they find out their ABFAS surgeon never completed a surgical residency. Especially when things go wrong.

At this point, I think we just need to trust the process. There are serious people with serious training and academic and real world credentials in leadership. All these grandfathered in pods have little to no control within the organization and they will be out of practice soon enough.

Studies show the ideal age is around 45 or so in terms of how old you prefer your doctor to be. Older than that they don't know the newest fancy of ways younger than that and they don't have enough experience. At this point I think there's other hills to die on other than grandfathered in avfas members it's a matter of time and father time always wins.

 

[diabeticfootdr]

The wrong answer is to make a backdoor simple route to skirt real eval of training and competence and outcomes. That will hurt the whole profession in many ways.

Just because something is harder doesn’t mean that it is better. What if they get the pass rate down to 1%? Is that even better?

A valid examination tests the standards of the residency program. The standards of the residency program are set by CPME. Programs are continually evaluated by CPME. They have on-site visits. If they don’t meet the standards, then they aren’t approved.

We don’t know what the CAQ pass rate will be. It is currently going through a rigorous process of internal development and validation set against the blueprint of CPME 320. It is the same process that we use to validate the ABPM certification exam, and the last pass rate was 86%.

Creating barriers to entry by making something harder, doesn’t make it fairer.

It’s time we stop eating our young.

 

[DYK343]

Totally agree. I am curious how many DPMs that are practicing never did a residency. They are getting closer to retirment. 10-15 years this problem will be more or less done with.

I guess I should backstep a little.

My favorite attending in residency did a 1 year residency. He is about 65 yo now plus or minus and quite possibly the best surgeon I ever worked with. Though this person was not doing IM nails or major rearfoot/trauma.

 

[Shiyuan]

Some hospitals actually do care.

Hospital I joined wants ABFAS certified (not qualified) and didnt interview anyone that didnt have ABFAS. Ortho/podiatry was not involved in this at least locally. Im sure there was ortho/podiatry influence at a higher level. Its a large hospital system and its what they want for their candidates (in additon to 3+ years real world experience).

“Hospitals” do (agree there), but I guarantee that the vast majority of individual MD/DO physicians and mid levels could not care less.

 

[DYK343]

Maybe “hospitals” (agree there), but I guarantee that the vast majority of individual MD/DO physicians and mid levels could not care less.

I agree. If there is someone on the floor who needs an I&D the hospitalist only cares that you can source control and eventually cure the infection.

But I wouldnt pigeon hole myself with only getting ABPM. Its the easiest way to board certification but you very well may get passed over for a job someday because you didnt spend the extra effort to get ABFAS. Also may have to get attorneys involved to get hospital surgical privileges.

I didnt think ABFAS was that hard. Passed foot/RRA 1st time. I guess its easy looking in rearview mirror. I may have only passed by a hair or knocked it out of the park. I dunno. But im not the worlds best fellowship trained surgeon or the smartest person in my class. I was a B+ student in school and managed to get good high volume balanced residency. Its passable. Over documenting surgical pre/post op notes I think is the key to passing the exam.

 

[heybrother]

Because life has a funny way of throwing your curve balls. So be prepared for change with ABFAS cert.

Listen to airbud people. This is a guy who has had so many opportunities. So many hospital and ortho groups. So many sign on bonuses paid back. Anyone else in the world would have had to move to New Jersey by now and convince old ladies that "the laser is working, you just need more". But not airbud.

That's the power of ABFAS and RRA. He's onto the next high paying job.

Gotta know when to frame 'em
Try not to maim 'em
Don't let them walk away
Until the x-rays done

 

[icebreaker32]

All this matters, yet does not matter, because the job market is horrible…..truth.

You can get hospital and insurance privileges many places being board qualified. If you never move most places they never even remove privileges if you never become board certified.

A podiatrist should certainly become board certified. If there was a good job market that is all that should matter.

If for argument sakes if ABPM with CAQ in surgery is equal to ABFAS Foot……it still will not matter, why? Insurance and hospital privileges are no longer the barriers they once were, the job market still is. All this ABPM CAQs is like smoke and mirrors to an extent because supply is much less than demand for good jobs, The job market will find something else. They will want fellowships, or ABFAS RRA etc. Status quo is not enough with severe over saturation for organizational jobs. If podiatrists were really in demand there would be multiple job offers with signing bonuses while still in residency with a stipulation you become board certified by any board within 5 years.

So let’s keep arguing over this and build more schools. In podiatry things are always changing on the surface, but at its core little changes..