Gatekeeping for incompetency

[AttackNME]

This isn’t something we exactly have talked about, but it’s important to be addressed.

How is incompetency currently defined so that it can be identified and addressed?

What options do residency and fellowship directors have for remediation of trainees?

What options do hospitals and podiatrists who are on the credentialing committee to appropriately deny priviledges to incompetent podiatrists?

I think it’s dangerous to assume everyone is competent just because they’ve graduated residency, and although it doesn’t happen often, there needs to be SOME gatekeeping, question is what does that look like when it’s appropriately done?

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[Adam Smasher]

Here's a wild idea:

Gatekeep at the podiatry school admissions stage

 

[DogSnoot]

Schools need to stop accepting everyone with a pulse and a check. Quality over quantity. Just looks at the statistics.

2021 - about 18,000 + Pods
2021 - about 4,000 + Vascular Surgery
2021 - about 3,000 + Sports Medicine (Orthopedic Surgery)
2021- about 12,000 + Derm


FAQ about Today's Podiatrists | APMA
Podiatrists

Number of People per Active Physician by Specialty, 2019

Number of People per Active Physician by Specialty, 2019

www.aamc.org

 

[Feli]

Same as it ever was:

Appropriate board cert (ABFAS for surgery/everything or ABPM for pod med/wound/etc),
case logs training,
case logs since,
talk to residency director,
talk to references (past dept chiefs, colleagues, etc),
proctor (if you think you need that, there is probably already a big problem),
etc.

ACFAS - Credentialing and Privileging Assistance
^^I have typically just followed those guidelines if asked for decision or imput on any bylaws or applicant decisions. Most places I know do same or similar. We can talk about the schools' nonsense, new schools, joke residencies, etc until we're blue in the face. Incompetent DPMs will always be a thing... at a higher incidence than most professions due to lax admissions on the front end and hastily created residencies with HIGHLY variable quality and board pass rates. If anyone is ever in the gatekeep positions, no way is perfect... but that following guidelines is a legit and generally safe and logical way to actually do it, though.

...the biggest problem about joke/diluted residencies is that the director probably knows the logs are falsified. They probably know they don't attract good students and that they don't churn out good residents. They know their program's in-training ABFAS results are bad, and most of their grads will fail BQ... and even if they pass BQ on re-take ("not in the residency anymore"... "out on their own"... "we can't be held responsible for that"), their alums may still fail or not even try for BC ABFAS afterwards. Those directors have every rea$$$on to say the program is ok or is turning the corner to APMA or reference calls, though. They will protect their job and their money. And as we all know, those programs continue to exist since the schools/grads need all of the residency spots they can find or hastily make.

So yeah, the board and the logs and the residencies all have to be the gatekeepers. We all know the schools sure won't do it... they just brag about high match rates in years there is a residency surplus, and they hum along and look the other way when a residency shortage or at least a serious shortage of good spots arrives. They will point to the notable alumni they all have and play dumb on the overall game and the many unmatched and questionable folks they've given a grad tassel to anyways. They accept and accept to their limits if they get even reasonable applicant interest. Same as it ever was.

 

[Scrantonicity]

I also have to believe that word gets around (especially negative experiences), so things have a way of sorting themselves out. The public isn't as stupid as we sometimes think, right? Or maybe they are haha...Hopefully the incompetent ones either end up not being that busy, or they figure out their strengths from trial and error and stick to those. I guess what happens a lot is they bounce around from job to job and inflict harm on hapless people wherever they go. Not sure what can be done about that unfortunately.

I just don't think we need every podiatrist under the sun accusing others of being incompetent and trying to gate keep...we have enough problems with general acceptance into the medical communities as it is without tearing each other apart...just my 2 cents.

 

[wakaflocka88]

Here's a wild idea:

Gatekeep at the podiatry school admissions stage

I pray too. But won’t happen. The ACFAS ABPM CPME AAPMC ABLES ASPS presidents and vice presidents and vice vice president and secretary and treasurer all have at least 1-2 old croony buddy pods that need a steady stream of chip and clip new grads along with fraudulent EpiFix daily applications. Remember what Rogers told us about the LECOM dean email - that we can’t shrink a profession to oblivion (something like that). I mean - 18000 current pods is just LOL. Ya right, good luck shrinking that. It’s so obvious and clear this is a perpetual red flag that our leaders outright skirt around it. Shameful.

 

[Adam Smasher]

I generally agree with ABFAS being the gold standard in credentialing. (I wonder if ABFAS blackballs me will I retire from surgery, haha.) Problem is someone who can churn out austins assembly line style isn't necessarily qualified to do our more intricate procedures. Also we have this arbitrary hierarchy where we act like ankle is more advanced than foot, when I'll go out on a limb and say many ankle procedures are easier than some foot procedures.

So from the perspective of a surgery dept chief how do you delineate core vs advanced surgical privileges? It's a bad look for all of us if we're stratified into nonoperative, osteomyelitis/wound cases only, forefoot, and rra, and meanwhile the average general surgeon CMO isn't going to bother caring to ask why the same doc who amputates a toe isn't perfectly qualified to reconstruct a flatfoot.

Not to mention the inevitable legal consideration where the pods who are "gatekept" may have a restraint of trade lawsuit, not that I'm espousing that sort of thing.

This is why pod school admissions is so crucial, because this is really the ONLY chance we have to block out the incompetent drs. If we conclude that admissions cannot/will not be constrained, we're all doomed

 

[Pronation]

Remember what Rogers told us about the LECOM dean email - that we can’t shrink a profession to oblivion

Probably one of the sleaziest lies I’ve heard from “leadership” so far.

 

[AttackNME]

I generally agree with ABFAS being the gold standard in credentialing. (I wonder if ABFAS blackballs me will I retire from surgery, haha.) Problem is someone who can churn out austins assembly line style isn't necessarily qualified to do our more intricate procedures. Also we have this arbitrary hierarchy where we act like ankle is more advanced than foot, when I'll go out on a limb and say many ankle procedures are easier than some foot procedures.

So from the perspective of a surgery dept chief how do you delineate core vs advanced surgical privileges? It's a bad look for all of us if we're stratified into nonoperative, osteomyelitis/wound cases only, forefoot, and rra, and meanwhile the average general surgeon CMO isn't going to bother caring to ask why the same doc who amputates a toe isn't perfectly qualified to reconstruct a flatfoot.

Not to mention the inevitable legal consideration where the pods who are "gatekept" may have a restraint of trade lawsuit, not that I'm espousing that sort of thing.

This is why pod school admissions is so crucial, because this is really the ONLY chance we have to block out the incompetent drs. If we conclude that admissions cannot/will not be constrained, we're all doomed

This is why I brought up this topic. While ideally yes we gatekeep at the school level, that isn’t the lever we can control right now. And even if we could control, how will a school admissions office guarantee that this college kid is going to be a good surgeon? Good grades doesn’t mean good surgeon. There needs to be good gatekeeping at ALL levels and blaming schools is the lazy answer.

Now the challenge I pose ourselves is how do we properly “fail” residents, how do we define what failure is, how do we define an incompetent 1st year who have not met milestones? What options do we have to send them to a year of remediation? these are very challenging questions that leadership has to deal with.

The Cpme document does not address this properly

 

[Pronation]

This is why I brought up this topic. While ideally yes we gatekeep at the school level, that isn’t the lever we can control right now. And even if we could control, how will a school admissions office guarantee that this college kid is going to be a good surgeon? Good grades doesn’t mean good surgeon. There needs to be good gatekeeping at ALL levels and blaming schools is the lazy answer.

Now the challenge I pose ourselves is how do we properly “fail” residents, how do we define what failure is, how do we define an incompetent 1st year who have not met milestones? What options do we have to send them to a year of remediation? these are very challenging questions that leadership has to deal with.

The Cpme document does not address this properly

This is exactly why there needs to exist chiropody and podiatry.

 

[call1800doctorb]

Here's a wild idea:

Gatekeep at the podiatry school admissions stage

This is the way.

 

[Adam Smasher]

@AttackNME

The problem is once someone has a DPM degree, all we can do is push you along and hope you're good enough at self assessing to know you shouldn't be operating.

At the residency stage, it's not like you can hold them back a year because then they just steal cases from their juniors. Any residency director who flunks a resident out is asking for a lawsuit.

At the licensing stage, I believe one of the Carolinas has a really hard state licensing exam, mainly for the purpose of keeping competition out, but ostensibly for protecting the public from inferior docs. You know who else would be good at administering a written test? The schools!

The only other choke point is board certification. Let's say we want you ABFAS certified to operate. Well you can only get certified if you have cases, so maybe we'll let you in the OR for the 7 years you're board qualified. What do you need to do to become board qualified? A written test!!!

So yes while good grades do not necessarily equal good surgeon, I have yet to meet anyone who was both book smart and incompetent surgically.