PM News: "Questions to the ABPM BOD"

[DexterMorganSK]

This type of news/debate never gets old. Looking for opinions here on this topic being shared on PM news.

Should an ABPM certified pod be allowed to do surgical procedures? How about those with ABFAS certifications?

Original Question (by Dr.Lombardi): Podiatry Management Online

Response by Dr. Rogers:

Response from others: Podiatry Management Online

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[JewOnThis]

Most hospitals will take both. I know some very surgically competent ABPM certified pods. The hospitals here will proctor a pod if you haven’t done cases in 3 months. It doesn’t matter if you are ABFAS or ABPM. Hospitals don’t care, it’s the pods who give other pods a hard time.

 

[CutsWithFury]

Most hospitals will take both. I know some very surgically competent ABPM certified pods. The hospitals here will proctor a pod if you haven’t done cases in 3 months. It doesn’t matter if you are ABFAS or ABPM. Hospitals don’t care, it’s the pods who give other pods a hard time.

This is the truth. It has nothing to do with other specialties opinion. Ortho only cares if its trauma. In some geographic regions ortho cares if it's in the ankle. But I would say 90% of the time is other podiatrists hating on other podiatrists.

 

[dtrack22]

Hospitals want to see board certification. Absent any podiatry presence, they have no idea what board certification we have available to us. If a facility requires ABFAS for surgical privileges then it’s almost certainly because a podiatrist has made that recommendation. Nobody else in medicine knows special podiatry boards exist, nor do they know what differentiates one from the other. If ortho wants to prevent you from doing something their solution is to have the hospital ask for case logs (which they themselves are rarely if ever required to produce for core privileges).

I guess on the off chance that a facility requires ABFAS for surgical privileges despite never having a podiatrist request or obtain surgical privileges; it is possible that an administrator got in touch with a colleague in another system and asked how they credential podiatrists. But that’s probably the least likely reason for required ABFAS certification

 

[GreenHousePub]

At my place if you are ABFAS certified you are placed in the Podiatric Surgery department. If you are ABPM you are placed in the Podiatry department. I'm in the former, no idea what the difference is with both.

 

[DYK343]

I cant operate at local hospital without ABFAS qualified/certified status.
ABPM not accepted. They are not going to budge on that. They are ortho, not podiatry.
Possible a podiatrist told them that. But that is the rules where I am and there are a lot of situations similar to mine out there.

 

[heybrother]

Here's something from an academic medical center near me where ortho runs the show. I found it interesting... like I'm sure in the future they'll be changing it to make it harder. I was talking to a friend at ACFAS where the hospital keeps increasing the number of ankle fractures a podiatrist has to do yearly to maintain ankle priviledges.

Procedure (Column):
Privileges included in Core:
Privileges to admit, evaluate, diagnose, consult, H&P, provide treatment, and perform surgical or non-surgical podiatric procedures on the toes and forefoot and perform simple rearfoot surgical procedures on patients presenting with injuries or diseases of the foot and ankle.

Privileges include:
Joint aspiration
Biopsies (soft tissue)
Digital surgery of all types plus surgical treatment of superficial neoplasm of the foot
Digital tendon surgery
Forefoot surgery - includes hallux valgus repair, metatarsophalangeal joint surgery, osteotomy of metatarsal, resection metatarsal and easily accessible tarsal exostoses.

Initial Criteria (Column)

Successful completion of a CPME approved one-year surgical residency, a one-year postgraduate training program in podiatric ortohpaedics, or a one-year postgraduate training program in primary in podiatric medicine or foreign equivalent training

AND EITHER
Current certification or active participation in the examination process leading to certification in podiatry by the American Board of Podiatric Surgery or Podiatric Orthopedics and Primary Podiatric Medicine or foreign equivalent training/board.

OR
Documentation or attestation of the management of podiatric problems and/or the performance of podiatric surgical procedures for at least 50 inpatients or ouatpeitns as the attending physican (or senior resident), at any accredited facility, during the past 2 years.

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Procedure: Advanced complex rearfoot and ankle surgical procedures

Criteria: Board certification in rearfoot/ankle surgery by ABPS or board qualified or completion of a 2 year podiatry residency. Documentation of performance of at least 20 Advanced Procedures.

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Procedure: Advanced Specialized Surgery, partial amputation, reconstructive surgery of forefoot, trauma of foot and ankle, Tendon-Achilles lengthening. All pedal tendon transfer procedures, Young flatfoot suspension, procedures, pantalar arthrodesis, ligamentous repair tarsus.

Criteria: Board certification in rear foot / ankle surgery by ABPS or board qualified or completion of a two year podiatry residency. Documentation of performance of at least 8 advanced specialized surgery procedures - must submit documentation log.

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Procedure: Ankle arthroscopy / Endoscopy

Criteria: Must also have advanced procedure priviledges. Ankle certification by *redacted* cause I'm not sure what it is.
Documentation and completion of suitable two day course ie. ACFAS or AOFAS. If board certifified in rear foot ankle and hold privledges at another facility with minimum of 12 cases in the past two years - please provide documentation log.

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Procedure: Orthotripsy
Criteria: Completed training with a license program.

 

[DexterMorganSK]

At my place if you are ABFAS certified you are placed in the Podiatric Surgery department. If you are ABPM you are placed in the Podiatry department. I'm in the former, no idea what the difference is with both.

The difference is probably the $$$

 

[diabeticfootdr]

I cant operate at local hospital without ABFAS qualified/certified status.
ABPM not accepted. They are not going to budge on that. They are ortho, not podiatry.
Possible a podiatrist told them that. But that is the rules where I am and there are a lot of situations similar to mine out there.

That violates Medicare Conditions of Participation. CMS doesn't care about urination contests between professions (or within a profession - like ours). They care about a Medicare patient's access to care - in this case, foot and ankle care.

First, a hospital is strictly prohibited from making decisions of hospital or surgical privileges based on board certification alone. But if certification is a required element of privileging, it has to be certification in one's primary specialty. In that case, ABPM and ABFAS both qualify. This did not come about because of podiatry. It is because of surgical subspecialties that tried to limit general surgeons from performing vascular surgery (for example).

Second, CMS and The Joint Commission (and many state laws) state that your privileges must be based on your education, training and experience.

Education is your DPM degree, standardized by CPME for decades now.

Training is your residency, standardized for all residents to include both podiatric medicine and surgery since 2005, and then to 3 years of podiatric medicine and surgery for all residents in 2011.

Experience is your case logs. You can be BC by ABFAS, but if you haven't performed an ankle arthroplasty, you're not going to be granted privileges to do one, regardless of your board certification.

Frankly, there is no difference in the qualifications (surgical or otherwise) in a graduate from today's CPME standardized Podiatric Medicine and Surgery Residency (PMSR) program regardless of your board certification. Both ABPM and ABFAS are recognized by the JCRSB of the CPME to certify in podiatry, considered by medicine to be our primary specialty.

The ABPM has challenged this when it is brought to our attention at hospitals across the country and we've been 100% successful in resolving it in favor of the podiatrist. Anyone who experiences such discrimination can contact the Board headquarters for assistance.

For more info see:
www.podiatryprivileges.com

JAPMA: Hospital and Surgical Privileges for Doctors of Podiatric Medicine: Hospital and Surgical Privileges for Doctors of Podiatric Medicine | Journal of the American Podiatric Medical Association | Allen Press

 

[CutsWithFury]

That violates Medicare Conditions of Participation. CMS doesn't care about urination contests between professions (or within a profession - like ours). They care about a Medicare patient's access to care - in this case, foot and ankle care.

First, a hospital is strictly prohibited from making decisions of hospital or surgical privileges based on board certification alone. But if certification is a required element of privileging, it has to be certification in one's primary specialty. In that case, ABPM and ABFAS both qualify. This did not come about because of podiatry. It is because of surgical subspecialties that tried to limit general surgeons from performing vascular surgery (for example).

Second, CMS and The Joint Commission (and many state laws) state that your privileges must be based on your education, training and experience.

Education is your DPM degree, standardized by CPME for decades now.

Training is your residency, standardized for all residents to include both podiatric medicine and surgery since 2005, and then to 3 years of podiatric medicine and surgery for all residents in 2011.

Experience is your case logs. You can be BC by ABFAS, but if you haven't performed an ankle arthroplasty, you're not going to be granted privileges to do one, regardless of your board certification.

Frankly, there is no difference in the qualifications (surgical or otherwise) in a graduate from today's CPME standardized Podiatric Medicine and Surgery Residency (PMSR) program regardless of your board certification. Both ABPM and ABFAS are recognized by the JCRSB of the CPME to certify in podiatry, considered by medicine to be our primary specialty.

The ABPM has challenged this when it is brought to our attention at hospitals across the country and we've been 100% successful in resolving it in favor of the podiatrist. Anyone who experiences such discrimination can contact the Board headquarters for assistance.

For more info see:
www.podiatryprivileges.com

JAPMA: Hospital and Surgical Privileges for Doctors of Podiatric Medicine: Hospital and Surgical Privileges for Doctors of Podiatric Medicine | Journal of the American Podiatric Medical Association | Allen Press

What happens when hospitals are just following what’s written into the state statutes? ABFAS is the only board certification allowed in my state of practice. It was written into the state laws and the department of health ensures the laws are followed by the hospitals.

 

[GreenHousePub]

That violates Medicare Conditions of Participation. CMS doesn't care about urination contests between professions (or within a profession - like ours). They care about a Medicare patient's access to care - in this case, foot and ankle care.

That may be so, but even if they are called out on it they will make it almost impossible to get privileges or operate.
Want to do a bunion? Show us 300 bunion cases you did in the past 12 months.

Want to do an ankle scope? Better be prepared to have 70 of them proctored before we allow you to do them. (And good luck finding anyone to proctor you...)

 

[diabeticfootdr]

What happens when hospitals are just following what’s written into the state statutes? ABFAS is the only board certification allowed in my state of practice. It was written into the state laws and the department of health ensures the laws are followed by the hospitals.

There are only 2 states where ABFAS is written into the statute (NY and CT) for ankle surgery. CT names ABPS specifically, NY says "a board acceptable to the NY Department of Professions which certifies in Rearfoot and Reconstructive Ankle Surgery," which you can interpret what that means. It is illegal in both cases and both will be challenged in the near future.

This is because licensure is different from privileges. Your licensure sets the boundaries of what you are allowed to do by law. Your privileges are set by the hospital/institution based on your individual capabilities. In order to become board certified, you must first be licensed. But both states are saying the opposite, in order to become licensed, you must first be board certified (or qualified). It's totally backwards and there is no comparator in the MD/DO licensure in any state.

 

[diabeticfootdr]

That may be so, but even if they are called out on it they will make it almost impossible to get privileges or operate.
Want to do a bunion? Show us 300 bunion cases you did in the past 12 months.

Want to do an ankle scope? Better be prepared to have 70 of them proctored before we allow you to do them. (And good luck finding anyone to proctor you...)

A hospital can't make the process too onerous. If they do, and the process is different from how they privilege an orthopedic surgeon, you can sue them for restraint of trade. Usually, just hiring a lawyer and that lawyer speaking to the hospital lawyer clears these things up. And if there is no one on staff who can (or willing to) proctor you, the hospital is required to bring in a proctor from outside.

 

[Utvolsdpm]

Now that this is brought up again does anyone have any insight into the case Blaine vs Ohio Health? This is essentially what is being discussed. Lost privileges at a hospital because not abfas certified. Went at least to Ohio Supreme Court, but lost the case. That was 2011, so maybe some things have changed? Also that individual may not have been ABPM certified at the time?

 

[619]

Now that this is brought up again does anyone have any insight into the case Blaine vs Ohio Health? This is essentially what is being discussed. Lost privileges at a hospital because not abfas certified. Went at least to Ohio Supreme Court, but lost the case. That was 2011, so maybe some things have changed? Also that individual may not have been ABPM certified at the time?

Blaine v. OhioHealth Corp.

Blaine v. OhioHealth Corp. - 2011-Ohio-4925

law.justia.com

 

[diabeticfootdr]

Blaine v. OhioHealth Corp.

Blaine v. OhioHealth Corp. - 2011-Ohio-4925

law.justia.com

The plaintiff failed his board certification exam 4 times and then decided to obtain certification from a board not recognized by CPME. Not sure there's anything else to say ...

Not to say that I'm not sympathetic when the pass rate for the ABFAS exam has been as low as 29% for first time test takers (foot qualification in 2017) and 31% for RRA.

 

[Utvolsdpm]

The plaintiff failed his board certification exam 4 times and then decided to obtain certification from a board not recognized by CPME. Not sure there's anything else to say ...

Not to say that I'm not sympathetic when the pass rate for the ABFAS exam has been as low as 29% for first time test takers (foot qualification in 2017) and 31% for RRA.

That’s the basic gist, but there was a little more to it than that (here’s some of the excerpts):

“Appellant was therefore required to obtain board certification from ABPS, the only "recognized certification board" specializing in podiatry”

“Appellant argues that, even if the hospital's bylaws require ABPS certification for podiatrists, then the bylaws improperly discriminate against those podiatrists who obtain certification through other podiatric boards. We disagree”

“Because ABPS is the recognized certification board in podiatry, §3.2-2(b) requires that all podiatrists obtain ABPS certification within five years.”

If he had been ABPM board certified it would be interesting to see how the ruling would go.

 

[G0dFather]

There are only 2 states where ABFAS is written into the statute (NY and CT) for ankle surgery. CT names ABPS specifically, NY says "a board acceptable to the NY Department of Professions which certifies in Rearfoot and Reconstructive Ankle Surgery," which you can interpret what that means. It is illegal in both cases and both will be challenged in the near future.

This is because licensure is different from privileges. Your licensure sets the boundaries of what you are allowed to do by law. Your privileges are set by the hospital/institution based on your individual capabilities. In order to become board certified, you must first be licensed. But both states are saying the opposite, in order to become licensed, you must first be board certified (or qualified). It's totally backwards and there is no comparator in the MD/DO licensure in any state.

TRUTH!!!!! ... thank you for clearing this up and stating FACTS !! instead of the BS stuff on this forum ... pods did this to themselves ..... the board cert should never limit a license !!!!!!!!!!!!!! terrible

 

[GreenHousePub]

The plaintiff failed his board certification exam 4 times and then decided to obtain certification from a board not recognized by CPME.

How did I know that when you mentioned "board not recognized" it was gonna be ABLES. I don't know anyone who even thought about their certification (expensive and worthless).