ABFAS and ABPM CAQ

[diabeticfootdr]

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.

This is mostly true.

Some bylaws automatically revoke privileges if you’re not certified within X years and they usually stipulate that it is not appealable.

And it’s why you need to read your hospital’s medical staff bylaws when you first get privileges. They make you sign a form that you received them and read them, but most people never do until there is an issue.

And the second thing you should do is volunteer to be on the bylaws committee immediately after you get on staff. No one wants to be on that committee. It’s boring. You can make a real different at that stage and change things in your favor.

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Members don't see this ad.

 

[air bud]

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

For the record never had to pay anything back in terms of signing bonuses. Did miss out on some loan payback. And only had to get one tail, 3 have been self insured. 2 MSG, 1 Ortho and now a hospital.

 

[msion]

Hospital admins really don’t know much about our training, same as coders really don’t understand podiatry coding.
In our hospital system we redid the entire privilege form based on the ABPM whitepaper about 3 years ago. The only modifications we made were regarding total ankles and arthrsocopies (ABFAS required or certain number of proctored cases). But the rest pretty much stays the same. The entire surgery department read and passed it without any issues. I sure hope this gets to stay without ABFAS causing more fuss.

https://abpmed.org/files/whitepaper/A%20Guide%20to%20Credentialing%20and%20Privileging%20DPM%20Credentialers.pdf?v=1561582965

 

[Feli]

...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...

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

It’s time we stop eating our young.

Yes, I think everyone knows this is the way things are supposed to work. That's the way CPME is supposed to function.

Does any legitimately believe that any DPM residencies are going to be shut down (involuntarily) with the upcoming addition of dozens and dozens more podiatry school seats, which will surely be filled if there is any applicant interest for them.

That tipping of the balance of students : residency spots obviously creates an urgent need for more residency spots... and the obvious APMA/CPME/AACPM play of expediting opening of new programs, pushing expanding spots at existing, and resisting closing any existing unless there is absolute unavoidable reasons. That's unfortunate.

It stands to follow that not too many programs will be closing or lowering number of spots - even if they should. There might be a shortage even with zero closures. The Atlanta VA and Phoenix VA and various NYC programs are "CPME approved." Being that some of the existing ones are low quality (as you attested to while in residency from personal experience), is it smart to just blindly trust the CPME process for who is competent and who should pass board certs with many residencies being of low quality and surgical volume? Is it smart to be the only surgical specialty MD/DO/DDS/DPM that does not evaluate cases the board certification candidate did via XRs, photos, chart review, oral exam, etc?

I get it that it seems like a dandy idea to be the people's champ and to try to stick it to "the man."
Sometimes I can't figure out if the altruistic blinders are on... or if the typing didn't even make sense as it was done, though.

 

[diabeticfootdr]

Here is the ABPM's full statement:

18 December 2023

Podiatrists, Stop Eating Our Young!

We are aware that another podiatry board issued a policy letter and requested its diplomates deliver it to their hospitals, which in part, reads “it would be in the best interests of patients for the hospital to require [their] Certification for podiatric surgeons.”

Obviously, this letter uncovers the desperation of elitism when it is challenged by truth.

There’s a saying in the profession: “Podiatrists eat their young.” We’ve all heard it. Many of us have even experienced it.

It means that some podiatrists use their positions of authority in the profession, their hospital, or their practice to take advantage of new podiatrists. This can be exhibited by policies that create hardships, restriction of surgical privileges, and reduced economic opportunities to the new podiatrist. Oftentimes, the root of this behavior is anticompetitive.

Board certification in podiatry has existed since 1975. There were once multiple boards, but through mergers and attrition now there are only two that are recognized by CPME. For the first two decades of podiatric board certification, the “founders” created the rules, like a club. They never completed the same entry requirements that new podiatrists must endure and they created lifetime certification for themselves so they wouldn’t have to retest.

Grandfathering and lifetime certification are phasing out, but the ABPM strongly opposes the undue hardship still caused by some other boards in podiatry which have no proven benefit on patient safety.

Specifically, we oppose:
- Creating a costly and multi-step process for board certification with subjective assessment of cases
- Fragmenting the specialty of podiatric surgery into 2 exams, increasing time and cost
- Not being transparent about scoring and pass rates
- Recommending hospitals limit surgical privileges to only their diplomates, alienating the rest of the profession who may be surgically-trained, competent, and even have achieved primary certification in podiatry

A certifying board’s primary duty is to protect the public. This is done through a process of examination to assess one’s cognitive knowledge. But have other podiatry boards ever proven that the public is better protected by a podiatrist with their particular certification versus one without it? The answer is a resounding NO!

A podiatrist’s education, training, and experience in the application of their knowledge and skills is what provides them the confidence and competence to medically and surgically treat the foot and ankle. The profession has advanced to a 3-year standardized residency training program. A board should test to the level of the CPME-approved residency training and not some arbitrary standard above that set by a club of podiatrists.

This discriminatory letter authored by another board is not consistent with the APMA’s position in its Hospital Privileging and Credentialing Resource Guide or with CMS Conditions of Participation (codified in federal law) which state that a provider's privileges be based on their education, training, and experience. CMS further clarifies that under no circumstances should board certification be the sole criterion in privileging, but if it is an element, that it be certification in one’s primary specialty.

The position espoused by the other board ignores the training a podiatrist receives in a standardized, CPME-approved residency training and disparages the entire profession by falsely accusing those without their certification as not competent to perform surgery and a risk to public safety.

If any podiatrist suffers any damages from the aforementioned letter, including denial or restriction of privileges, we want to know about it immediately. Please contact the ABPM Headquarters.

The ABPM takes its role in protecting the public very seriously while promoting parity with other boards and nondiscrimination of all podiatrists. Our exam is validated by independent psychometrists. The pass rate of the recent ABPM certification exam was 86%, commensurate with MD and DO primary and specialty boards. Contrary to baseless accusations, ABPM is not an easier board, ABPM is a fairer board. It’s what the profession and our patients deserve.

Thank you for your support as we continue Certifying Today’s Podiatrist and moving Podiatry Forward.

The ABPM Board of Directors

Podiatrists, Stop Eating Our Young!

We are aware that another podiatry board issued a policy letter and requested its diplomates deliver it to their hospitals, which in part, reads “it would be in the best interests of patients for the

myemail.constantcontact.com

 

[AttackNME]

if you’re interested in how broken the healthcare system in terms of what it means to be a competent physician, and how complicated and broken the licensing, credentialing, and reporting system is, look at this video



If you don’t know about Dr Duntsch and his horrific surgical outcomes (Dr Death) it’s a good lesson on how the whole surgical privileging system has problems much deeper than board certification.

 

[icebreaker32]

It is good we have two boards because with ABFAS only the board certification rate would be embarrassing low and hospital and insurance privileges would be difficult for more of this profession without ABPM.

We should take an honest look at why the ABFAS pass rate is currently so low as everyone now does the same type of residency. The profession has decided we are surgical specialty with mandatory 3 year surgical residencies.....so why can not we have one surgical board. The answer lies in our history and evolution of profession which would take pages and pages to discuss.

1. Were students admitted with too low of academic standards? Most would say didactically ABFAS is harder. Is it it too hard? Is ABPM too easy?......is up for debate.

2. Did we try to become a surgical specialty when we are extremely saturated as a profession for everyone to be surgeons when much of podiatry is elective surgery and saturated in most areas. Podiatrists are not guaranteed call when they graduate to get surgical cases. Not all PP positions for graduates are busy surgically. Unpaid hospital call and diabetic foot does not make economic sense usually for those who are not employed by a hospital. Most are in private practice. There are not enough organizational jobs. Private practice can take a while to build up surgical volume especially if you open your own office.

3. Yes ABFAS has its problems. Yes they grandfathered people in that are aging out. Yes it has left a few people behind that are both good surgeons and were good students, that did not have the required diversity or had unfortunate employment situations but those are the exceptions.

4. Do I think ABFAS would consider fixing it shortcomings without a competing board? Probably not.

The process does not care who you are or who you know. You have to earn it.

They tried to fix the diversity concern. They could still probably further improve the case review process.

5. As I will keep saying the job market is a much, much larger problem. If applicants increase the new schools are making the largest problem in this profession worse.....saturation with a poor job market.

6. Let be very realistic ABPM with a CAQ in surgery is not your golden ticket to a good job.....you better combine that with a good limb salvage fellowship and be geographically open for that. You don't need ABFAS in most area to get hospital and surgical privileges anyways, if you just want to do private practice. The problem is no longer hospital privileges in most parts of the country.

6. I understand we currently need two boards ad ABFAS leaves too many people behind. The real question I have is why does ABPM need CAQs. Not the reasons they are saying....for those who want to do more. That was the answer for boards, but that is not why people go through the process. They do it for hospital and insurance credentialing along with helping them to apply for jobs.

My feeling it is for money and power for ABPM (not saying that is necessarily bad or different from ABFAS) and a play for the limb salvage hospital/academic market. Do not fool yourself that hospital and academic limb salvage market will not be for all of ABPM......you will need ABPM, CAQs, combined with a good limb salvage fellowship and very often need to be geographically open also.

The job market is way too saturated for all to get good jobs. Even ACFAS is pushing for ABFAS diplomats to get fellowships.

In a saturated job market status quo is never good enough....you will need something to separate yourself from the masses. People can cry for parity and then some other elitist path will just develop due to market forces in this profession.

 

[LossToFollowUp]

"Podiatrist eat their young" is absolutely endemic in our profession but not due to the certification process. The young are getting destroyed by salaries offered from current greedy gatekeepers. There is no reason an associate bringing in over 600k is only earning 20% of that outside of owner greed. If your business overhead is truly 70-80%, your business has major major flaws.

I believe ABFAS has tremendous flaws and ABPM with CAQ is significantly misguided. The truth of the matter is not every podiatrist deserves to be certified regardless of the board. With Dr. Roger's explanation of how the CAQ process is "fairer" with their studies, how do you explain the process surgical MDs go through? Ortho definitely undergoes a rigorous case review process. My ortho friend told me about how Dr. Sanders destroyed one of his colleagues over a calc fracture case that was submitted.

We need to fix the current certification situation with ABFAS and streamline it more closely with the MDs. We are better off creating the situation where we can tell any surgical credentialing committee we are certified just the same way you are". Lets be realistic, MDs do not care to understand our process and never will. We are only harming ourselves

 

[Feli]

"Podiatrist eat their young" is absolutely endemic in our profession but not due to the certification process. The young are getting destroyed by salaries offered from current greedy gatekeepers. There is no reason an associate bringing in over 600k is only earning 20% of that outside of owner greed. If your business overhead is truly 70-80%, your business has major major flaws.

I believe ABFAS has tremendous flaws and ABPM with CAQ is significantly misguided. The truth of the matter is not every podiatrist deserves to be certified regardless of the board. With Dr. Roger's explanation of how the CAQ process is "fairer" with their studies, how do you explain the process surgical MDs go through? Ortho definitely undergoes a rigorous case review process. My ortho friend told me about how Dr. Sanders destroyed one of his colleagues over a calc fracture case that was submitted.

We need to fix the current certification situation with ABFAS and streamline it more closely with the MDs. We are better off creating the situation where we can tell any surgical credentialing committee we are certified just the same way you are". Lets be realistic, MDs do not care to understand our process and never will. We are only harming ourselves

This is an excellent eval... top to bottom.

Podiatry definitely "eats its young" in terms of salaries. That's about where it tends to stop.
Some older DPMs try to control hospital privileging or hiring, but it's pretty hard for anyone 1yr or 2yr surgical trained to try to exclude a 3yr DPM who has passed ABFAS BQ/BC and strong case logs. In terms of boards, most who are RRA cert are middle aged or young. Most who are ABFAS BQ/BC and in ACFAS are younger docs overall... higher rates than ever. Obviously, most who are 3yr trained, fellowship, etc are younger DPMs.

One well-respected former SDN longtime user liked to say that "many people would say it's actually the other way around" (young eat the older DPMs) in terms of surgical training, medical rotations/training, hospital and MSG jobs, hospital privileges, proficiency at RRA, etc. The case can be made for that also.

At the end of the day, every profession regulates and polices itself. Competency (and incompetency), both didactic and in practice, are the job of the overall profession.

 

[diabeticfootdr]

...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.

Very observant. Also CPME now mandates both in-training exams.

 

[JewOnThis]

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

These dinosaurs were probably grandfathered in. Even the foot part is a difficult exam to pass especially with the non sense case reviews.

 

[JewOnThis]

ABFAS is a scam. There are at least 3-4 podiatrists that aren’t ABFAS certified in my area that are arguably better at doing certain type of surgeries than me. So to me, ABFAS again is just a scam but it’s a scam we must join (if you can) to continue with this garbage profession.

 

[Junior Associate Laborer]

If you are board qualified by ABFAS, is the ABPM CAQ even worth the time, effort and $295?

I don't think the CAQ is going to score me any additional points with credentialling departments.

Going through the certification process now for ABFAS and the case audit was enough of a headache to get from my facility so I'm looking forward to gathering all the case review documentation.

 

[Adam Smasher]

is the ABPM CAQ even worth the time, effort and $295?

I don't think the CAQ is going to score me any additional points with credentialling departments.

answered your own question

 

[air bud]

If you are board qualified by ABFAS, is the ABPM CAQ even worth the time, effort and $295?

I don't think the CAQ is going to score me any additional points with credentialling departments.

Going through the certification process now for ABFAS and the case audit was enough of a headache to get from my facility so I'm looking forward to gathering all the case review documentation.

Feel even worse for the Junior Assistant associate laborer.

 

[Feli]

If you are board qualified by ABFAS, is the ABPM CAQ even worth the time, effort and $295?

I don't think the CAQ is going to score me any additional points with credentialling departments.

Going through the certification process now for ABFAS and the case audit was enough of a headache to get from my facility so I'm looking forward to gathering all the case review documentation.

The CAQ won't do anything that fake boards or just good case logs or good interview and CV making skills wouldn't do (get you surgical privileges at places that give them to anyone who applies). The only places CAQ gets you "additional points" are situations you don't need points. As I said awhile ago, a CAQ "surgery" that can be had by people who have never done one surgery as an attending makes you look like you're trying to be deceptive to any DPM who knows anything... aka most who are in positions of hiring, cred, privi, admin, etc. You'd be better off with just good case logs and ABFAS BQ.

Decision tree kinda goes like this:

 

[Junior Associate Laborer]

So if I don't pass ABFAS case review in the next 5 years I'll get the CAQH, maybe the old dinosaur pod that I work for will offer me a path to partnership in 5 years!

 

[wakaflocka88]

So if I don't pass ABFAS case review in the next 5 years I'll get the CAQH, maybe the old dinosaur pod that I work for will offer me a path to partnership in 5 years!

You will pass after they milk you for at least 2-3 year’s worth of $$$.

 

[DPM TRUTH]

Happy new year collegues!!!

Let a 35 year practicing attending correct some of the younger posters on here.

They stated: The only places CAQ gets you "additional points" are situations you don't need points.

Incorrect. As division chief of podiatry/wife division chief of Orthopedics the CAQ does make a difference. We are at a large hospital (12 ORs) in a metro area for background. The caq ALSO separates physicians who completed a 3 year PM&S-36 residency vs. Some of the abfas members ( some that were grandfathered in that never did a surgical residency all). This makes it much easier for credentialing. And yes, people like myself (who hold abfas/abpm cert) who have practiced for 35+ years are more than capable of helping out credential cases. And stop with the false narrative "there aren't a lot of these grandfathered in people left". There are a ton of them left still with active licenses.

So students/residents please understand the abfas allowed some (with their changing yearly rules) diplomats to become board certified without EVER competing a surgical residency via the alternative method. I will be posting how this "alternative method" worked step by step so people can understand how corrupt it was. Maybe the "young gurus" don't understand how crazy it was.

Also.....That letter acfas send abpm is sick.

Hey abfas/abfas gurus on here.... is not inviting abpm to acfas because the AOFAS will not invite you to their conference? Wonder why no other medical speciality (including my wife as a foot and ankle orthopedic surgeon) cares if you have abpm vs abfas.

It's OK, keep those "grandfathered in" people in power making these decisions. Maybe one day acfas will address having ACTIVE members that NEVER completed a surgical residency!

So that's a little "dose of reality" from someone 35 years out, not . I understand though, 10-15 years out (like some posting on here) I also though I knew everything also!

 

[LossToFollowUp]

Incorrect. As division chief of podiatry/wife division chief of Orthopedics the CAQ does make a difference. We are at a large hospital (12 ORs) in a metro area for background. The caq ALSO separates physicians who completed a 3 year PM&S-36 residency vs. Some of the abfas members ( some that were grandfathered in that never did a surgical residency all). This makes it much easier for credentialing. And yes, people like myself (who hold abfas/abpm cert) who have practiced for 35+ years are more than capable of helping out credential cases. And stop with the false narrative "there aren't a lot of these grandfathered in people left". There are a ton of them left still with active licenses.

Can you clarify this paragraph? How are you justifying the CAQ as a clear separation from grandfathered individuals?

Also since you stated your wife is chief ortho and that you yourself are ABFAS cert, how do you view ABPM stance on discrediting the value of case review? Are you considering CAQ to be equivalent to ABFAS cert?

 

[DPM TRUTH]

Certainly loss2followup

Grandfathered individuals were not required to complete a surgical residency. They were allowed to sit for the boards (up until 2000 if I remember correctly) by "proving they did some cases". Completely diffrent set of rules vs. others.

When I have one of these individuals to credential how do I know their experience NOT completing a surgical residency? If you never completed a surgical residency how do you manage in house patients? If you never completed a surgical residency you were not exposed to other surgical services (vasc/ortho). Just because "you scrubbed some cases with someone" does not replace a surgical residency. But for some reason the abps (now abfas) allowed some people to "get through" with diffrent rules.

Again, for the thousandth time - someone who will hold the abpm caq is much more qualified to do 80% of what we do vs. The "guy" who holds abfas foot cert because he was grandfathered in and never completed a surgical residency. The difference is abfas/acfas doesn't want to address this and keep these individuals out of surgery while putting their head in the sand about the grandfathered in/foot and ankle crowd. Wonder why?

So back to your question #1. It will be much easier to credential someone with abpm/caq vs. "The abfas foot crowd" - notice the RRA crowd is NOT included here because they were NOT allowed to be grandfathered in like some in the foot crowd. We all know EXACTLY what the abpm caq requires. There are not separate rules based on what year you passed. UNIFORMITY!

For question #2 I don't think they are equivalent because the abpm caq has a diffrent value vs. Abfas. If you wanna join an orthopedic practice and do tons of trauma, by all means go abfas route. If your buying a PP practice to do simple forefoot and some would care the abfas does not fit your cases/practice style but the abpm caq does. Some private practices don't have the case diversity for abfas. They only do forefoot. That doesn't make them "wrong". So no, I don't see them equal, just diffrent tools people can use to practice THE WAY THEY WANT.

look at the abpm/abfas issue like the ortho vs. Podiatry issue. Why do we need another surgical board when we already have the
The American Board of Orthopedic Surgery? Because we did not meet the "requirements" to sit for the ortho boards....so what did they do? Made ANOTHER surgical board....the abfas.

 

[LossToFollowUp]

Thank you for your reply. I actually agree with your thought process and how you would approach grandfathered people vs CAQ. But let's be honest, this is not how CAQ would used nationally. ABPM/Dr. Rogers have justified their process by trivializing the importance of case review. It's clear they want to be held equivalent in comparison to ABFAS. Simply put, we have a surgical board in ABFAS vs a medicine board trying to provide surgical acumen through an exam.

ABFAS themselves are broken and need a revamp but CAQ is not the answer.

 

[heybrother]

It was 1991. We've covered this, repeatedly.

Can anyone anywhere point out to me a podiatrist they know who is practicing, actively surgical, and grandfathered into ABFAS.

 

[DPM TRUTH]

Heybrother

Two diffrent things here. Everyone prior to 1991 was grandfathered in to "foot and ankle surgery". We are not talking about this group (although it was wrong to do that also with never touching an ankle). We are talking about the late 1990s/early 2000s for the foot surgery crowd, not foot and ankle crowd.

And yes, there are a good number of these people (just 20-25 years out from early 2000's) still on staff. We have a handful here.

So again, why are these people who played by completely difftent rules (foot and ankle crowd/grandfathered in) allowed to join acfas? Think about it....someone who NEVER did a surgical residency can join acfas but a pms-36 trained can not with abpm caq? Still wondering who thinks this is "fair"?

 

[diabeticfootdr]

ABPM/Dr. Rogers have justified their process by trivializing the importance of case review.

It’s not trivial, it’s not objective. Our psychometrists (who all work for the same company as other boards) tell us that case review is subjective and has high risk of bias.

We all know people that have failed case review when they should have been passed.

Board exams can’t determine your skill. They can determine your knowledge. Your skill can only be determined by direct observation.

There are at least 3 other opportunities for direct observation in a surgeon’s career; residency director attesting to a trainee’s skill, proctoring during privileging, and peer review.

 

[GreenHousePub]

It was 1991. We've covered this, repeatedly.

Can anyone anywhere point out to me a podiatrist they know who is practicing, actively surgical, and grandfathered into ABFAS.

I know several.

 

[heybrother]

I know several.

Interesting. I try to always look people's names up whenever I read something I'm always surprised by how many people are multi-year trained, RRA, etc even when I'm reading something trivial.