Questions for Podiatry's Leaders

[air bud]

Texans love nothing more than Texas. But will UTRGV really only accept Texans going forward?

There are 6 texas residency programs with 18 residency positions. If those all now move towards UTRGV this will strain the applicant pool especially with LECOM opening.

I sincerely hope AACPM/APMA are doing everything they can to prevent this from developing into a disaster. With historically low applicant pools this will obviously help them but what happens if we get a surge in applicants/normal applicant levels?

I know i've been harsh but I honestly do care about the matriculants and their future.

Not to derail... but what is the obsession with Texas? I love that they love it so much. Their loyalty is pretty awesome and I like it. But its flat, hot, and spread out. I've only been to Dallas, Houston, and Austin so im not an expert. The BBQ is top notch. Ill give them that!

BBQ and that is about it. West Texas is cool, not like Midland and Odessa, but Marfa and that area. Hill country is pretty. But Houston/Dallas there is no beauty, no attractions other than the fact that there is people and business to be done.

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[heybrother]

Go to a Mexican restaurant in the Midwest and they will literally put something tasting like bland marinara on a table to eat with your chips. In Texas restaurants routinely serve salsa so spicy out of staters can't eat it. The last time I went to interviews I ordered a margarita for my co-resident at the Pappasitos in the Dallas airport. Pappa-etc restaurants are a chain, albeit a good one. Airport food doesn't normally shine. My co-resident became literally sloppy drunk off this 1 margarita which he also admitted was the best he'd ever had in his life. Fell asleep on the airplane after slurring his words for awhile.

Texans are literally taught we are awesome in school. Two hundred Mexican traitors, aka early Texans, died at at the Alamo and we celebrate it.

King of the Hill

Tubing in the Hill Country

No libs (haha, jk, we're a purple state now).

High school football.

Gulfcoast seafood until BP lubed the gulf. I used to eat huge $0.25 oysters at happy hours.

Gruene General Store (childhood memory)

Historically cheap housing with no state income tax

Hot chicks

Jeans and cowboys boots to work

Getting passed by a truck on a 2 lane road going 100 miles an hour towing a boat on labor day (ugh, ok that sucks)

HEB

Iowans call Guacamole "Avacado Dip". Seriously.

Super cheap college at the right places, apparently UTRGV.

Hot as hell almost everywhere

I started trying to write a response for Dr. Rodgers but wrote this instead.

 

[GreenHousePub]

So why has no one brought up that BLS has published that Podiatry as a field has a slow growth outlook based on BLS that is more than 50% below other professions?

Podiatrists : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics

Podiatrists provide medical and surgical care for people with foot, ankle, and lower leg problems.

www.bls.gov

 

[Boba Foot]

Texas will do its part. UTRGV students are from TX and most want to be trained and practice in TX.

Do you feel like the four major cities plus El Paso have enough demand for a whole new class of pods every year? When I was job searching this time last year it appeared that the cities are pretty well saturated, and in addition you have major hospital systems like BSW who do not hire podiatrists.

Not to derail... but what is the obsession with Texas?

IYKYK. Hate the politics here, but the food is great, cost of living is good (but not as good as it was a decade ago), and the winters are good. Winters were brutal in the north east and I do not like cold weather for 5 months a year. Plus there are good road trips around the state to do on weekends, good live music, decent sports teams. People are nice. Was very difficult for me to adjust to people’s attitudes in the north east.

 

[icebreaker32]

There is no reason to create 80 residency slots right now.

Texas will do its part. UTRGV students are from TX and most want to be trained and practice in TX.

Yes 80 slots are not needed....now.

Most of the Texas residencies are decent and usually only fill with less than 50 percent Texas residents.

If total podiatry school enrollment does increase residencies can not just be created instantly. Enrollment where it is now things are fine.

I guess if/when enrollment returns to enough to fill all seats many are worried based on past history of another residency crisis which has happened more than once.

It is less about blaming the new schools and just wishing there could be a cap on enrollment to be less than the previous years residency slots.

 

[icebreaker32]

Do you feel like the four major cities plus El Paso have enough demand for a whole new class of pods every year? When I was job searching this time last year it appeared that the cities are pretty well saturated, and in addition you have major hospital systems like BSW who do not hire podiatrists.

IYKYK. Hate the politics here, but the food is great, cost of living is good (but not as good as it was a decade ago), and the winters are good. Winters were brutal in the north east and I do not like cold weather for 5 months a year. Plus there are good road trips around the state to do on weekends, good live music, decent sports teams. People are nice. Was very difficult for me to adjust to people’s attitudes in the north east.

Well said about Texas in other posts above.

Good cost of living (as mentioned not as good as in the past) and schools good in the suburbs. Mix of conservative gun loving people and a melting pot of ethnicities in the large cities.

No way there be will 80 jobs in Texas.

The one thing many large cities (metros) in Texas have going for them is population growth. Lots of PP. Many go through the typical associate first then open up on their own in a far suburb and do well enough eventually. Income for podiatry above average in Texas.

Time will tell if saturation becomes brutal in Texas or not. My guess is it will become like Florida…..many established podiatrists that are doing very well, with associate salaries going down. The desirable jobs will become more competitive……better do a fellowship or get ABFAS.

 

[icebreaker32]

So why has no one brought up that BLS has published that Podiatry as a field has a slow growth outlook based on BLS that is more than 50% below other professions?

Podiatrists : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics

Podiatrists provide medical and surgical care for people with foot, ankle, and lower leg problems.

www.bls.gov

I bring it up all the time.

Numerous outside studies/publications have basically said we have a trickle of growth and mainly replace retiring podiatrists. Now and in the future.

No crazy growth on the horizon for podiatry due to diabetes etc. That is why it is so crucial to control supply if we want a decent job market. Huge demand with no shortage in sight for RNs, CRNAs, PAs, NPs, MDs, foreign MDs, Caribbean MDs, DOs. etc. These are just the facts.

 

[diabeticfootdr]

Texans love nothing more than Texas. But will UTRGV really only accept Texans going forward?

UTRGV is mandated to take 90% Texans. The inaugural class was 26 Texans/1 from out of state.

And ... yee haw!

Here is the order of power in Texas:

1. God
2. University of Texas
3. George Strait

 

[diabeticfootdr]

Any information on LECOM?

I just got Dr. Jason Lee's (Dean of LECOM) email address and reached out to him for comment. Will post if he replies.

 

[diabeticfootdr]

Here is a response from Moriath North, Executive Director of the AACPM.

Regarding the demand for podiatric physicians:


Currently, there are approximately 15,000 practicing podiatrists in the United States. After the current U.S. census, that means there are over 20,000 potential patients per practicing podiatrist. According to the Bureau of Labor Statistics (BLS), podiatric physicians held over 10,000 full time jobs in 2018. Despite these statistics, employment of podiatrists is projected to grow 6% from 2018-2028, as fast as the average for all occupations, according to the BLS. Additionally, patients will seek the services of a DPM for lower extremity care due to the rising number of injuries in an active population, the growing rates of obesity and diabetes, and the increasingly older population. One must also consider the upcoming retirement of current DPMs desiring to retire in the next decade. The American Podiatric Medical Association (APMA) reports its average member is 53 years of age and seeks to retire between the ages of 61 and 70.

 

[diabeticfootdr]

From Moriath North, Executive Director of the AACPM:

General information regarding AACPM:

The American Association of Colleges of Podiatric Medicine (AACPM) is a nationally recognized education association that serves as a resource to students, residents, and practitioners by providing direct access to academic institutions; highlighting opportunities for clerkships and residencies; and linking students to mentors that guide their career development.

AACPM’s mission is to serve as the leader in facilitating and promoting excellence in podiatric medical education leading to the delivery of the highest quality lower extremity healthcare to the public. AACPM’s membership consists of eleven podiatric medical schools and more than 200 hospitals and institutions that offer postdoctoral training in podiatric medicine. The Association serves as a national forum for the exchange of ideas, issues formation and concerns relating to podiatric medical education.

AACPM’s vision is to ensure, through collaboration and other appropriate means, that academic podiatric medicine is a vibrant community of schools and residency programs and other entities staffed with administrators, teachers, and researchers capable of educating and training a podiatric workforce relevant to the needs of the public, generating new biomedical knowledge and providing academically based health services.

The AACPM administers several national service programs, including:

AACPMAS – Centralized Application
Centralized application service known as which processes all applications submitted for admission to the podiatric medical schools.

Clerkship Program
An online application and matching service for third year students applying for their third- and fourth-year clerkship rotations.

CASPR – Central Application Service for Podiatric Residencies
Application and matching service for fourth year students interested in applying for residency positions in teaching hospitals.

CRIP – Centralized Residency Interview Program
The CRIP interview process provides a means of saving time and money as hospital faculty and residency candidates interview together in one major city for one six-day period in January each year.

AACPM is an Affiliated Organization of the American Podiatric Medical Association (APMA), which represents practicing podiatric physicians in the USA.

 

[diabeticfootdr]

From Moriath North, Executive Director of the AACPM:

General information regarding AACPM:

The American Association of Colleges of Podiatric Medicine (AACPM) is a nationally recognized education association that serves as a resource to students, residents, and practitioners by providing direct access to academic institutions; highlighting opportunities for clerkships and residencies; and linking students to mentors that guide their career development.

AACPM’s mission is to serve as the leader in facilitating and promoting excellence in podiatric medical education leading to the delivery of the highest quality lower extremity healthcare to the public. AACPM’s membership consists of eleven podiatric medical schools and more than 200 hospitals and institutions that offer postdoctoral training in podiatric medicine. The Association serves as a national forum for the exchange of ideas, issues formation and concerns relating to podiatric medical education.

AACPM’s vision is to ensure, through collaboration and other appropriate means, that academic podiatric medicine is a vibrant community of schools and residency programs and other entities staffed with administrators, teachers, and researchers capable of educating and training a podiatric workforce relevant to the needs of the public, generating new biomedical knowledge and providing academically based health services.

The AACPM administers several national service programs, including:

AACPMAS – Centralized Application
Centralized application service known as which processes all applications submitted for admission to the podiatric medical schools.

Clerkship Program
An online application and matching service for third year students applying for their third- and fourth-year clerkship rotations.

CASPR – Central Application Service for Podiatric Residencies
Application and matching service for fourth year students interested in applying for residency positions in teaching hospitals.

CRIP – Centralized Residency Interview Program
The CRIP interview process provides a means of saving time and money as hospital faculty and residency candidates interview together in one major city for one six-day period in January each year.

AACPM is an Affiliated Organization of the American Podiatric Medical Association (APMA), which represents practicing podiatric physicians in the USA.

Ms. North also pointed out how the role of CPME (in accrediting the schools) is different from AACPM with this statement:

From CPME’s website “About” page:

The Council on Podiatric Medical Education is an autonomous accrediting agency for podiatric medical education. Deriving its authority from the House of Delegates of the American Podiatric Medical Association, the Council is empowered to develop and adopt standards and policies as necessary for the implementation of all aspects of its accreditation, approval, and recognition purview.

The Council has final authority for:

· The accreditation of colleges of podiatric medicine, the approval of fellowships and residency programs, and providers of continuing education, and the recognition of specialty certifying boards for podiatric medical practice.

The Council is recognized by the Council for Higher Education Accreditation (CHEA) and the US Secretary of Education as the accrediting agency for first professional degree programs in podiatric medicine. Unqualified recognitions by these organizations have recently been extended for the maximum periods available.

The Council also holds membership in the Association of Specialized and Professional Accreditors (ASPA), agreeing with and abiding by the ASPA Code of Good Practice. The ASPA Code of Good Practice is oriented towards the work of accrediting organizations as a guide in establishing the principles on which relationships with programs and institutions should be based.

 

[Adam Smasher]

Additionally, patients will seek the services of a DPM for lower extremity care due to the rising number of injuries in an active population, the growing rates of obesity and diabetes, and the increasingly older population.

Again, I want to know if any thought is being given to precisely what type of "lower extremity care" is in demand. Last week, I had a day with 5 new patients. 4 of them were octogenarians in need of nail trimming. Now, this may be unique to my particular practice situation. But do we as a profession truly believe that the most efficient way to meet this demand is by producing more 7-year trained graduates?

 

[Pronation]

Again, I want to know if any thought is being given to precisely what type of "lower extremity care" is in demand. Last week, I had a day with 5 new patients. 4 of them were octogenarians in need of nail trimming. Now, this may be unique to my particular practice situation. But do we as a profession truly believe that the most efficient way to meet this demand is by producing more 7-year trained graduates?

We all know the answer to this already... this is just more smoke and mirrors to satisfy a self-serving agenda.

 

[GreenHousePub]

Here is a response from Moriath North, Executive Director of the AACPM.

Regarding the demand for podiatric physicians:
Despite these statistics, employment of podiatrists is projected to grow 6% from 2018-2028, as fast as the average for all occupations, according to the BLS.

This is directly contradictory against the BLS own statement, who on their website claim employment of podiatrists is projected to grow only 2%, below average for all occupations.

Job Outlook​

Employment of podiatrists is projected to grow 2 percent from 2021 to 2031, slower than the average for all occupations.

Despite limited employment growth, about 300 openings for podiatrists are projected each year, on average, over the decade. Most of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
Last Modified Date: Friday, September 23, 2022

Who are we to believe? The BLS website or the director of podiatry colleges (which are for-profit institutions that only benefit by increased student enrollment).

In that same statement she states that the only growth to be expected is from podiatrists retiring at age 60? So hope the older generation dies out instead of an actual need taking place?

Anecdotally I've met a ton of podiatrists well into their 70s and still practicing (mainly to sell their practices with a 1 million price tag to an unsuspecting bag-holder).

 

[wakaflocka88]

As Adam Smasher noted above, this projected BLS growth is not accurate. Our profession has set a precedent that we are going to be professional nail trimmers and patients seek this out. I even have patients that tell me they don’t know what a nail salon is, because they’ve always had their nails taken care of by another pod and they’ve referred their entire clan. Of course the demand will keeep going up if this shenanigan keeps up for non qualified high risk foot care. The list goes on.

 

[diabeticfootdr]

But do you believe the BLS data for Physicians and Surgeons? (see attached) Growing slower than average at 3% and a median wage of $208,000???

One of the issues with this data about salary is that is comes from tax records of W-2 income.

1. Your IRS forms have to identify you as a podiatrist in your job taxonomy or your data isn't in this set. My accountant has frequently listed mine a physician.
2. If BLS says there are 11,000 podiatrist in the US, and 600 x 3 years are residents, that is 1800, or 16% of the total podiatry population that is calculating a mean for the income. Residents mean income is significantly lower and will pull down the overall mean.
3. Private practice pods (which there are a lot of) who are self employed are using strategies to limit their W-2 income. They might pay themselves a salary of the maximum for Social Security and Medicare Tax at $147,000 and take the rest of their income as distributions or dividends. Furthermore, it doesn't calculate the tax benefit of paying for mixed-use business expenses with tax free business money. For example a corporate car, home office, telephone, etc. Those benefits can be significant and would not be included in this calculation, again, driving down the mean.

Just food for thought.

From the FAQs on the BLS page

1. What is a benchmark of payroll survey estimates from the Current Employment Statistics (CES) survey?
   Answer: The benchmark adjustment, a standard part of the Current Employment Statistics (CES) survey estimation process, is a once-a-year re-anchoring of sample-based employment estimates to full population counts available principally through Unemployment Insurance (UI) tax records filed by employers with state labor market information agencies. More information about the CES benchmarking process is available in the CES Frequently Asked Questions at www.bls.gov/web/empsit/cesfaq.htm#Benchmarking and in the CES Technical Notes at www.bls.gov/web/empsit/cestn.htm#section6b.

 

[icebreaker32]

Podiatry is saturated if one expects a good job with a good ROI and good benefits upon completion of residency for the vast majority.

If one considers nursing home care, the non desirable PP jobs (yes some good ones exist and there are not enough of them) or has the ability/creativity to find the capital to open their own office, the risk tolerance for it and wants to run a small business with its own long list of pros and cons then maybe it is not completely saturated yet in some parts of the country.

if there was unmet podiatric demand to any great extent the job market would be better than it is.

Can one do well eventually in podiatry, yes many do and some do not. For the majority that end up doing well it was not due to a great job market caused by unmet demand.

If one finished in the top 25 percent of their class and got a top residency one might get a great first job. Way too many students think this is how it will be for everyone. Does it mean podiatry is a bad career choice for everyone.....no. One needs to know podiatry has a more questionable ROI than many other professions and will not have good available jobs in any city they want. Certainly some do very, very well in this profession. Some is not all.

 

[AttackNME]

Here is a response from Moriath North, Executive Director of the AACPM.

Regarding the demand for podiatric physicians:


Currently, there are approximately 15,000 practicing podiatrists in the United States. After the current U.S. census, that means there are over 20,000 potential patients per practicing podiatrist. According to the Bureau of Labor Statistics (BLS), podiatric physicians held over 10,000 full time jobs in 2018. Despite these statistics, employment of podiatrists is projected to grow 6% from 2018-2028, as fast as the average for all occupations, according to the BLS. Additionally, patients will seek the services of a DPM for lower extremity care due to the rising number of injuries in an active population, the growing rates of obesity and diabetes, and the increasingly older population. One must also consider the upcoming retirement of current DPMs desiring to retire in the next decade. The American Podiatric Medical Association (APMA) reports its average member is 53 years of age and seeks to retire between the ages of 61 and 70.

Is this the only source used by our leaders to determine how many podiatrists are needed? What if the data is flawed or misinterpreted? Is there an expert on this stuff that we as a profession could consult regarding how to properly serve their population? Are there any ramifications to our leaders if they got this wrong? Because a lot of people will be affected by something that could probably have been researched more in the front end.

 

[heybrother]

#1 - Anytime someone in the leadership says "residency surplus" - we need to be there saying how bad many of the programs are.

#2 - There isn't going to be a residency crisis in 2026 because of collapsing matriculation, BUT we need to continue to hammer the disingenuous nature of the schools, our leadership, and the profession for how they regulate schools and residency creation. If the schools could all snap their fingers and be full tomorrow they'd do it till their hands were sore. No consideration would be given to the pain they'd rain on their graduating students. The opening of UTRGV and LECOM was entirely independent of and without any consideration of the recent matriculation collapse. The schools had been in the works for years - it just happened to be they opened now. If every school had been full they would still have opened. No true residency genesis would be forthcoming and another crisis would would have been impending. This recent phenomenon of students getting to give the finger to VAs and NYC would have ended. Class of 2026 students should be thanking God every night that no one wants to be a podiatrist because you as a class would probably have been hurt terribly.

#3 - Podiatry could use this current crisis as an opportunity to change. Consider that in 2018 three of the podiatry schools had graduation rates that are sub-75%. A discussion above concerning non-performing residencies stated that terminating non-performance would be harmful to programs and residents. The problem is the terrible things in podiatry have been terrible forever. If leadership wants to take the ammunition out of our mouths - do something about all the embarrassments in the profession. This profession refuses to go after the things that insiders and outsiders slaughter us with. All of the podiatry schools years ago should have been forced to set a 25 (historic average) MCAT score. We could have started the process of disarming so many of the stones thrown at us if we'd raised standards.

#4 - Make no mistake. We're hearing from people in the leadership because leadership is terrified. You might not know it from the canned text and they've faced dangers in the past - but they are down like 200+ students in matriculation this year.

#5 - Leadership can't make a private practice podiatrist give you a fair shake. They can't make non-competes illegal.

#6 - They can't make Humana/United healthcare value our services. They can't reduce the expansion of Medicare Advantage plans. They are probably trying to fight the Medicare fee schedule cut coming next year, but its coming regardless. For all this talk of increasing need for our services ("age", "fat", "diabetes" - cringe, is that how you want more business) - whether anyone wants to pay for our services is another story.

 

[podwho]

Can leadership do anything about all the as***** podiatrists who care about nothing but them selves? That tbh is half the problem. It must be one of the most self serving professions. Keep what you have and throw everyone else under.

I guess the real question is does leadership even have the power or influence to enact meaningful change at any level?

Also if you want real data just call and ask every single graduate in the last 5 years. Ask about their salary, number of jobs, and if they are in their desired location. That's maybe 3k people. It's not some unknowable data. Publish that and if it shows good ROI then you'll fill every single seat for next year. Not that complicated.

Oh but it may require some money that you can't get back. Let's see how much leadership actually cares to find real answers. "3% job growth over 10 yrs" means literally nothing.

Edit... Got to McKinsey and ask for help and show them this thread. They will laugh and feel so bad they may consult for you guys for free. Having said that I respect the public outreach

 

[GreenHousePub]

But do you believe the BLS data for Physicians and Surgeons? (see attached) Growing slower than average at 3% and a median wage of $208,000???

One of the issues with this data about salary is that is comes from tax records of W-2 income.

1. Your IRS forms have to identify you as a podiatrist in your job taxonomy or your data isn't in this set. My accountant has frequently listed mine a physician.
2. If BLS says there are 11,000 podiatrist in the US, and 600 x 3 years are residents, that is 1800, or 16% of the total podiatry population that is calculating a mean for the income. Residents mean income is significantly lower and will pull down the overall mean.
3. Private practice pods (which there are a lot of) who are self employed are using strategies to limit their W-2 income. They might pay themselves a salary of the maximum for Social Security and Medicare Tax at $147,000 and take the rest of their income as distributions or dividends. Furthermore, it doesn't calculate the tax benefit of paying for mixed-use business expenses with tax free business money. For example a corporate car, home office, telephone, etc. Those benefits can be significant and would not be included in this calculation, again, driving down the mean.

Just food for thought.

From the FAQs on the BLS page

1. What is a benchmark of payroll survey estimates from the Current Employment Statistics (CES) survey?
   Answer: The benchmark adjustment, a standard part of the Current Employment Statistics (CES) survey estimation process, is a once-a-year re-anchoring of sample-based employment estimates to full population counts available principally through Unemployment Insurance (UI) tax records filed by employers with state labor market information agencies. More information about the CES benchmarking process is available in the CES Frequently Asked Questions at www.bls.gov/web/empsit/cesfaq.htm#Benchmarking and in the CES Technical Notes at www.bls.gov/web/empsit/cestn.htm#section6b.

View attachment 363206View attachment 363207

This was a good rebuttal, glad to see another perspective on it.

 

[Pronation]

#1 - Anytime someone in the leadership says "residency surplus" - we need to be there saying how bad many of the programs are.

#2 - There isn't going to be a residency crisis in 2026 because of collapsing matriculation, BUT we need to continue to hammer the disingenuous nature of the schools, our leadership, and the profession for how they regulate schools and residency creation. If the schools could all snap their fingers and be full tomorrow they'd do it till their hands were sore. No consideration would be given to the pain they'd rain on their graduating students. The opening of UTRGV and LECOM was entirely independent of and without any consideration of the recent matriculation collapse. The schools had been in the works for years - it just happened to be they opened now. If every school had been full they would still have opened. No true residency genesis would be forthcoming and another crisis would would have been impending. This recent phenomenon of students getting to give the finger to VAs and NYC would have ended. Class of 2026 students should be thanking God every night that no one wants to be a podiatrist because you as a class would probably have been hurt terribly.

#3 - Podiatry could use this current crisis as an opportunity to change. Consider that in 2018 three of the podiatry schools had graduation rates that are sub-75%. A discussion above concerning non-performing residencies stated that terminating non-performance would be harmful to programs and residents. The problem is the terrible things in podiatry have been terrible forever. If leadership wants to take the ammunition out of our mouths - do something about all the embarrassments in the profession. This profession refuses to go after the things that insiders and outsiders slaughter us with. All of the podiatry schools years ago should have been forced to set a 25 (historic average) MCAT score. We could have started the process of disarming so many of the stones thrown at us if we'd raised standards.

#4 - Make no mistake. We're hearing from people in the leadership because leadership is terrified. You might not know it from the canned text and they've faced dangers in the past - but they are down like 200+ students in matriculation this year.

#5 - Leadership can't make a private practice podiatrist give you a fair shake. They can't make non-competes illegal.

#6 - They can't make Humana/United healthcare value our services. They can't reduce the expansion of Medicare Advantage plans. They are probably trying to fight the Medicare fee schedule cut coming next year, but its coming regardless. For all this talk of increasing need for our services ("age", "fat", "diabetes" - cringe, is that how you want more business) - whether anyone wants to pay for our services is another story.

MODS!!!!!

I demand action for @heybrother posting this.

My recommendation is to make his post a sticky.

Thx

 

[Feli]

Can leadership do anything about all the as***** podiatrists who care about nothing but them selves? That tbh is half the problem. It must be one of the most self serving professions. Keep what you have and throw everyone else under. ...

This is all a product of saturation, man.

The saturation in various areas or overall leads to the lowball salary jobs, uber-competition between docs, quasi-fraud and fraud billing, etc.

Look at chiro... it's not as if "a-hole chiro DCs" come out of school wanting to be cutthroat competitive, needing to make backdoor deals with PTs for some patients to do manipulations on, needing to take out tons of ads and write a weekly newspaper column just to half-fill the schedule. I doubt that most pre-chiros are wanting to recommend full-spine manip for a headache or to sell vitamins and health books and insoles and 100 other things in the office.

In podiatry, one can gripe about the low associate salaries or the few good residencies or the OTC products or the lack/difficulty of hospital jobs. As long as podiatry DPM jobs with 100k base + 25% keep getting dozens of applicants calling and visiting or non-op and minimal-op VA jobs for $200k or whatever are highly coveted, then they will persist. As long as podiatry is not highly profitable, it will be pretty hard to get loans to start up a practice solo or to buy one out.

If you have a solid education and skill (school and residency) and solid supply/demand, the income and job satisfaction take care of themselves. You don't really see that saturation and the unfortunate things it causes in most MD specialties - outside of perhaps HIGHLY popular areas - as the schools are much more selective on the front end and each specialty's training spots are kept high quality and the numbers are tightly regulated. It is almost no problem for an ortho or plastic or colo-rectal surgeon to get a loan to start an office or buy partnership; banks know they have an in-demand skill and the office will kill it. They also know that, worst case, those docs can go get a 500k job at a hospital if their PP happened to go belly-up. They are rare and in demand. Numbers game. Bottom line.

 

[diabeticfootdr]

I had an email communication with Dr. Jason Lee, Dean of the LECOM School of Podiatry.

He said LECOM has a plan to create residency positions as they have in the past.

He also wrote something I thought to be profound in regards to the suggestion that the profession reduce class sizes across the country, “You can't shrink a profession into prosperity.”

I didn’t get permission to share his whole email, but I found him to be knowledgeable, innovative, conscientious, and a visionary.

He’s also pretty young. He reminded me that we met at Broadlawns Medical Center in 2008/9 when he was a student at DMU rotating with me. I was performing a BKA with ortho and he held the leg.

I think LECOM’s feet are in good hands.

 

[DYK343]

I had an email communication with Dr. Jason Lee, Dean of the LECOM School of Podiatry.

He said LECOM has a plan to create residency positions as they have in the past.

He also wrote something I thought to be profound in regards to the suggestion that the profession reduce class sizes across the country, “You can't shrink a profession into prosperity.”

I didn’t get permission to share his whole email, but I found him to be knowledgeable, innovative, conscientious, and a visionary.

He’s also pretty young. He reminded me that we met at Broadlawns Medical Center in 2008/9 when he was a student at DMU rotating with me. I was performing a BKA with ortho and he held the leg.

I think LECOM’s feet are in good hands.

I appreciate you reaching out.

I still remain very nervous for matriculating classes on a man's words of "LECOM has a plan to create residency positions".

 

[Pod2death]

I had an email communication with Dr. Jason Lee, Dean of the LECOM School of Podiatry.

He said LECOM has a plan to create residency positions as they have in the past.

He also wrote something I thought to be profound in regards to the suggestion that the profession reduce class sizes across the country, “You can't shrink a profession into prosperity.”

I didn’t get permission to share his whole email, but I found him to be knowledgeable, innovative, conscientious, and a visionary.

He’s also pretty young. He reminded me that we met at Broadlawns Medical Center in 2008/9 when he was a student at DMU rotating with me. I was performing a BKA with ortho and he held the leg.

I think LECOM’s feet are in good hands.

Actions > Words. I am not trying to call anyone out, Dr. Lee may be a great physician. I only have very, very limited interaction with him. But just because he wrote you a nice email doesn't forgive that his program has consistently produced Podiatrists that are a detriment to the profession.

You may not be able to shrink a profession into prosperity but you can certainly drown one with sub par standards.


I do appreciate you taking the time to do this. I may not agree with a lot of it, but I do recognize the work being put into it to keep the discourse flowing.

 

[Pronation]

He also wrote something I thought to be profound in regards to the suggestion that the profession reduce class sizes across the country, “You can't shrink a profession into prosperity.”

Profound indeed.

Profoundly deceptive.

This is all seems very similar to how the bad press initially came out about GameStop’s stock last year to try to save Melvin capital from going under.

Melvin Capital, hedge fund torpedoed by the GameStop frenzy, is shutting down. The firm lost billions of dollars as it scrambled to cover its bets against the video game retailer that became a darling of retail traders.

 

[de Ribas]

I appreciate you reaching out.

I still remain very nervous for matriculating classes on a man's words of "LECOM has a plan to create residency positions".

The plan will remain, residency spots - no.

 

[msion]

I had an email communication with Dr. Jason Lee, Dean of the LECOM School of Podiatry.

He said LECOM has a plan to create residency positions as they have in the past.

He also wrote something I thought to be profound in regards to the suggestion that the profession reduce class sizes across the country, “You can't shrink a profession into prosperity.”

I didn’t get permission to share his whole email, but I found him to be knowledgeable, innovative, conscientious, and a visionary.

He’s also pretty young. He reminded me that we met at Broadlawns Medical Center in 2008/9 when he was a student at DMU rotating with me. I was performing a BKA with ortho and he held the leg.

I think LECOM’s feet are in good hands.

Well I do respect you and agree with most of the stuff that you said or did for the profession, I really can't agree on this one.

There are a little over 7000 plastic surgeons in the US. And let's not even talk about plastic surgeon's scope of practice.
We have four extremities plus the spine and there are about 20000 orthopedic surgeons in the US.
Vascular surgeons? 4000.

We have anywhere around 15-18k podiatrists in the country, that's just too many.
Supply and demand are real. Scarcity brings up the value of a profession.

We should cap our numbers at 5000. This will definitely make podiatry the best kept secret again. And if we look at all the crazy stuff podiatry associations have done in the past, they are really all about making the profession more exclusive. 3 yr residency vs. the prior generation, ABFAS vs. ABPM, the added CAQ or other wound boards. And of course now fellowships. What they were really doing is to build the wall taller. "You are not good enough if you just did a 3-year residency to practice podiatry. You have to pass this, this and then this." The last time a profession did that was pharmacy and they were (are) so saturated.

 

[icebreaker32]

Yes we are saturated. We are all 3 years trained with "surgical" residencies.

It almost is not worth it to mess with toenails due to audits, low reimbursement and strict rules etc in PP......that being said how many retiring podiatrists are seeing lots of this? We better replace them not let that work go to an RN......no unmet demand allowed. Furthermore how many need this to get diabetics into their practice, or to get patients of any kind in the office and treat "other pathology" they mention pain to that callus you need X-rays, ultrasound now and oh that deep callus is now not a callus it is an ulcer $$$. How many are brave enough to tell their referring doctors I will not accept referrals for this type stuff?

Students should certainly seek out the best training they can. You can not blame them for considering a fellowship in this job market if it gives them an edge.

If there was legitimate demand you would not ABFAS plus potentially RRA plus potentially a fellowship or maybe ABPM and a limb salvage fellowship to get a good job. If we were in demand you would just need a pulse and an unrestricted state license. I know several MDs that lost their license, then get it back and are put on probation and others they have no narcotics license for several years while on probation also.....they still get hospital jobs. Some got kicked out of their groups, but no worries and no need to move to find a good job. They get a hospital job 20 minutes away. A couple of those even eventually lost their license for good in the future, but the risk of them doing the same thing they got in trouble in the past for again in the future did not stop the hospital from taking a chance on them. That is called demand.

 

[heybrother]

Emergency Medicine:

Radiation Oncology

The Future of our Field - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

The ASTRO Board of Directors issued a position statement: “The future of the U.S. radiation oncology workforce.”

www.astro.org

Two fields. Both enviable compared to podiatry. Both with changing dynamics where overproduction has likely clouded their future.

 

[AttackNME]

Emergency Medicine:
View attachment 363322

Radiation Oncology

The Future of our Field - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

The ASTRO Board of Directors issued a position statement: “The future of the U.S. radiation oncology workforce.”

www.astro.org

Two fields. Both enviable compared to podiatry. Both with changing dynamics where overproduction has likely clouded their future.

Wonder is there an expert on this stuff? Someone who consults on management of over/under-production of people within the profession

 

[air bud]

Emergency Medicine:
View attachment 363322

Radiation Oncology

The Future of our Field - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

The ASTRO Board of Directors issued a position statement: “The future of the U.S. radiation oncology workforce.”

www.astro.org

Two fields. Both enviable compared to podiatry. Both with changing dynamics where overproduction has likely clouded their future.

There is a surplus of EM physicians because there are non-physicians taking those roles and we know what those results are....i am seeing them now.

 

[dtrack22]

There is a surplus of EM physicians because there are non-physicians taking those roles and we know what those results are....i am seeing them now.

Also, EM has been the fastest growing specialty in terms of new residency seats in medicine over the last 5-10 years. They are producing more docs at a time when PE is coming in and cutting costs with mid levels and out of network billing shenanigans that ED and Anesthesia groups have used to make a killing, are finally being reigned in by state/fed gov

It should be another great supply and demand lesson for our profession, but most of us weren’t smart enough to get into medical school so I’m not sure we can be expected to understand such a simple economic principle

 

[icebreaker32]

There is a surplus of EM physicians because there are non-physicians taking those roles and we know what those results are....i am seeing them now.

Disagree know lots of locums working ER shifts for a few weeks half way across the country working as much or as little as they want. Also know family practice docs making extra money by covering podunk ERs on weekend.

Maybe there are a couple markets they are saturated in, unlike podiatry where we only have a couple markets we are not saturated in. Come to think of it many of the ER locums I know were from NY or Florida, possibly they are saturated there, but plenty of work for them I promise you for locums. I figured they did locums for more time off and more money, but saturation is a possibility. It was hard to feel sorry for them. One of them had a home in Sarasota, FL that increased in value over an additional million dollars over COVID and they were taking more time off to travel and spend more time on their true passion of kitesurfing .

If there are any sign of saturations, MDs just chose different specialties and foreign/offshore trained start picking them up. Hard to believe now, but anesthesia was once a specialty that was avoided by many due to decreasing salaries by hospitals decades ago.

 

[wakaflocka88]

Dr. Rogers, what is going to happen now that ABFAS recently released a mass email detailing their thoughts on the CAQ? Is anything being done to weed out unnecessary “certifications” and try to unite as a whole?

 

[AttackNME]

Surgical privileges are granted initially based on training. Board certification is to demonstrated proficiency within a field or expertise but not required by hospitals to grant privileges. Dr Rogers can you explain what’s the point of board certification then?

 

[diabeticfootdr]

Surgical privileges are granted initially based on training. Board certification is to demonstrated proficiency within a field or expertise but not required by hospitals to grant privileges. Dr Rogers can you explain what’s the point of board certification then?

You're right.

From the day you finish residency you're competent enough to a hospital to do surgery for a period of 5 years. Sometimes you can get that extended to 7 years (for obvious reasons), but some hospitals won't budge. The duration is published in the medical staff bylaws.

Then after you cross that 5-year threshold ... all of a sudden ... you're no longer competent, despite your case volume.

(Side note: We've actually fought many of these and won)

Even another board in podiatry says you're competent after you finish your CPME-approved residency training, then if you don't pay a bunch of money and pass several tests, you're not competent. Their latest letter is the most direct attack on the profession's surgical privileges I've ever seen. It essentially calls 70% or more of the profession incompetent and a threat to public safety. Never doubt the ability of elitists in podiatric surgery from harming you more than any orthopedist or anyone outside the profession could.

Historically, board certification (in any specialty) was a voluntary step to demonstrate expertise beyond the minimal competence of licensure. However, in modern days, if you don't become BC, you'll find difficulty getting hospital privileges and getting in network (or in some cases even paid) by insurance companies. Medicare is an exception.

Essentially, board certification indicates to the public, your peers, and governing bodies that you have attained a level beyond minimal competency in your specialty. Continued certification indicates that you're staying up to date in your field.

I think it will only become more of a requirement in the future, right or wrong.

 

[diabeticfootdr]

Dr. Rogers, what is going to happen now that ABFAS recently released a mass email detailing their thoughts on the CAQ? Is anything being done to weed out unnecessary “certifications” and try to unite as a whole?

We are always willing to sit at the table with them, we have many times actually. I think we could come up with a system that works better for the profession and is a fair assessment of competence for podiatrists.

Recently, we offered to meet with them without any pre-conditions.

But let me be clear that the ABPM is moving full-speed ahead with the CAQ and our defense of ABPM BC. We promote fairness, parity, and equity in podiatry.

 

[AttackNME]

You're right.

From the day you finish residency you're competent enough to a hospital to do surgery for a period of 5 years. Sometimes you can get that extended to 7 years (for obvious reasons), but some hospitals won't budge. The duration is published in the medical staff bylaws.

Then after you cross that 5-year threshold ... all of a sudden ... you're no longer competent, despite your case volume.

(Side note: We've actually fought many of these and won)

Even another board in podiatry says you're competent after you finish your CPME-approved residency training, then if you don't pay a bunch of money and pass several tests, you're not competent. Their latest letter is the most direct attack on the profession's surgical privileges I've ever seen. It essentially calls 70% or more of the profession incompetent and a threat to public safety. Never doubt the ability of elitists in podiatric surgery from harming you more than any orthopedist or anyone outside the profession could.

Historically, board certification (in any specialty) was a voluntary step to demonstrate expertise beyond the minimal competence of licensure. However, in modern days, if you don't become BC, you'll find difficulty getting hospital privileges and getting in network (or in some cases even paid) by insurance companies. Medicare is an exception.

Essentially, board certification indicates to the public, your peers, and governing bodies that you have attained a level beyond minimal competency in your specialty. Continued certification indicates that you're staying up to date in your field.

I think it will only become more of a requirement in the future, right or wrong.

Thanks for the clarification. I think most people aren't aware of this. From the ABFAS perspective, I'm assuming they're concerned about people with poor training being allowed to maintain surgical privileges. Do you believe that it is possible someone could complete 3-year training and still be surgically incompetent? If so, how should the profession address this issue? I'm aware that defining incompetency is also a touchy and difficult topic.

 

[Feli]

...But let me be clear that the ABPM is moving full-speed ahead with the CAQ and our defense of ABPM BC. We promote fairness, parity, and equity in podiatry.

What do you honestly expect a CAQ in surgery from the non-surgical board to say to an employer the person is applying to?
What does it say to a hospital with any surgical DPM (or Ortho, Gen, etc surgeon) who knows and understands our boards?

From today's politico that you typed up:
"...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 ..."

You are talking about passing a written test... written.
There is no parallel for this in orthopedic surgery, general, plastic, ENT, OB, or any other surgical specialty... all have didactic + case reviews for board cert.

Meanwhile, in podiatry, somebody who did any bottom-of-the-barrel DPM residency could have a cert in podiatric medicine, and now they could have a certificate in podiatric surgery (from the medicine board!) if they are minimally competent in written test-taking? They could do all this without ever having done a single OR surgery themselves - and maybe the never will... yet they are CAQ for surgery forever if they will pay their dues. Does that make any sense to you?? Someone who has never done a toe amp or a soft tissue mass can be lifetime cert for surgery? It does not make any sense to me.

...Personally, I'd look at someone with the ABPM's CAQ in surgery and lacking ABFAS BQ/BC the same way as I look at someone who is "certified" by Am Board Multiple Specialties in Podiatry or "certified" by Am Board Lower Extremity Surgeons without ABPM and/or ABFAS. Using deceptive boards is a sizable red flag worse than someone with no board cert at all or only 1yr residency or etc - yet being transparent about it. Having no cert might be due to ESL, poor test taker, lack of residencies in the past, various personal factors. Having a fake cert shows me that the person is actively trying to deceive... likely trying to do things and board cases they are NOT well trained for. Those are typically the most dangerous types of docs and why falsifying residency training, boards, case logs, etc is typically an auto-reject from most hospitals. That has to be considered here.

 

[DPM TRUTH]

What does it say to a hospital with any surgical DPM (or Ortho, Gen, etc surgeon ) who knows and understands our boards?

Great question, especially the following two coherts:

A. ) those grandfathered into the abfas
B.) Those got in the back door via the alternative method to the abfas

Why did abfas make exceptions? Should the abfas members who never completed a surgical residency have surgical privileges?

Personally, I'd look at someone with the abfas certificate in foot and ankle surgery the same way as I look at someone who is "certified" by Am Board Multiple Specialties in Podiatry or "certified" by Am Board Lower Extremity Surgeons without ABPM and/or ABFAS. Using deceptive boards is a sizable red flag worse and much than someone with no board cert at all or 1yr residency or etc - yet being transparent about it.

 

[Feli]

What does it say to a hospital with any surgical DPM (or Ortho, Gen, etc surgeon ) who knows and understands our boards?

Great question, especially the following two coherts:

A. ) those grandfathered into the abfas
B.) Those got in the back door via the alternative method to the abfas

Why did abfas make exceptions? Should the abfas members who never completed a surgical residency have surgical privileges?

Personally, I'd look at someone with the abfas certificate in foot and ankle surgery the same way as I look at someone who is "certified" by Am Board Multiple Specialties in Podiatry or "certified" by Am Board Lower Extremity Surgeons without ABPM and/or ABFAS. Using deceptive boards is a sizable red flag worse and much than someone with no board cert at all or 1yr residency or etc - yet being transparent about it.

I'm not sure that using the recognized surgical board structure that was in place at the time that DPM graduated/trained is deceptive, but yes... you need case logs for the ABFAS Foot and Ankle cert docs (as you do for any ABFAS BQ docs). I have run across maybe one or two of such in my 10yrs of practice, though.

I think you are repeatedly overblowing a "problem" that happened decades ago and is solving itself?
And weren't you banned... or just suspended?

 

[DPM TRUTH]

you need case logs for the ABFAS Foot and Ankle cert docs (as you do for any ABFAS BQ docs). I have run across maybe one or two of such in my 10yrs of practice, though.

How many ankles did those case logs NEED to include for foot and ankle surgery? Zero is the answer.

So it's not deceptive to board yourself in a specialty you never had experience with? Many of these "abfas diplomats" did just that. So yes, the process was deceptive with ZERO oversight.

So yes, this is very confusing to other specialties. They don't understand how you can be boarded in foot and ankle surgery without ever touching an ankle!

In my 35 years of practice I have ran across this many times. These dpms feel "entitled" to ankles because their abfas certificate says foot and ankle surgery.

 

[Pronation]

What does it say to a hospital with any surgical DPM (or Ortho, Gen, etc surgeon ) who knows and understands our boards?

Great question, especially the following two coherts:

A. ) those grandfathered into the abfas
B.) Those got in the back door via the alternative method to the abfas

Why did abfas make exceptions? Should the abfas members who never completed a surgical residency have surgical privileges?

Personally, I'd look at someone with the abfas certificate in foot and ankle surgery the same way as I look at someone who is "certified" by Am Board Multiple Specialties in Podiatry or "certified" by Am Board Lower Extremity Surgeons without ABPM and/or ABFAS. Using deceptive boards is a sizable red flag worse and much than someone with no board cert at all or 1yr residency or etc - yet being transparent about it.

I know that people say going the backdoor route is considered taboo but some find that it feels better for them. Just food for thot.

 

[diabeticfootdr]

What do you honestly expect a CAQ in surgery from the non-surgical board to say to an employer the person is applying to?

Huh? We are not the "non-surgical board". We are the American Board of Podiatric Medicine and we offer multiple independently-validated examinations. One of those examinations is the ABPM Certification Exam which is the recognized exam by CPME for podiatric orthopaedics and primary podiatric medicine.

Also we're all DPMs, we're not DPSs.

You are talking about passing a written test... written.

First, that's not all one must do to be eligible, explained below. Second, I'm always open to suggestions. So please, tell me how to create a psychometrically-valid, objective assessment of one's surgical knowledge or ability? We've been through this with psychometrists over-and-over.

ABPM actually used to require case documentation for its certification exam. Our external psychometrists (who are the same for many boards, BTW) told us it was impossible to make those assessment objective. And then we decided to separately evaluate them and we found that cases made little difference in the overall pass rate. Therefore, if it's a subjective measure and makes little to no difference, why do it? Except to gate keep. Furthermore, it was the biggest liability for the ABPM (and I'll argue any certifying board, because it will be why a board gets sued. They won't get sued over a validated multiple choice question.

If you want to take this one step further and say, yes, but you must evaluate someones skill, not just their knowledge, for them to do surgery. There are already skills assessments in place ... also subjective, but they are there.
1. The skills assessment in residency training (which could be improved and do you know who tried to improve it at the CPME 320 rewrite ... we did!)
2. The privileging process. Both in the initial granting of privileges and continued privileges. It is when you can have direct observation by a peer and if you have too many failures or infections, the system is supposed to re-review.

Meanwhile, in podiatry, somebody who did any bottom-of-the-barrel DPM residency could have a cert in podiatric medicine, and now they could have a certificate in podiatric surgery (from the medicine board!) if they are minimally competent in written test-taking? They could do all this without ever having done a single OR surgery themselves - and maybe the never will... yet they are CAQ for surgery forever if they will pay their dues. Does that make any sense to you?? Someone who has never done a toe amp or a soft tissue mass can be lifetime cert for surgery? It does not make any sense to me.

Totally false. The CAQ is not a demonstration of minimal competence. That is a licensing exam. You have to be first licensed and board certified before you sit for a CAQ. You've already met minimal competence.

And you have to have surgical privileges in addition to primary board certification in order to be eligible to sit for the CAQ in PS. You must continue to demonstrate those surgical privileges. If you lose your privileges, your CAQ in PS is revoked.

And you like to point out the Pathway 1 which is only for those who finished their residency within the past 3 years. Already we've established in many posts that everyone thinks you're competent to do surgery then, the other board, hospitals, governments, peers, etc. Because if you weren't competent, why would you get granted surgical privileges? Do you think you get privileges to independently "practice" on people and complete your Jedi training? The real answer is that you have proximity to your training and the volume of cases you were required to do by CPME is considered sufficient. Even the CMS requirements which state that clinical privileges must be based on a provider's education, training, and experience, is further clarified as current experience. That is defined as the last 24 months of surgical activity.

We recognize that in Pathway 1. (We chose 3 years instead of 2 based on the timing of the CAQ exams in March and that is not a full year from when you finish residency in July, so we thought is was more fair to be 3 years - which is really 2 years and 8 months).

In Pathway 2, if you are more than 3 years out, you must demonstrate your current experience by a case documentation process. How many cases should you submit? You tell me? It doesn't mean those are the only cases you've performed. It's a representative sample of your surgical work in a diversity of categories. How many is fair to demonstrate that? Please, and I'm not being sarcastic, tell me how many is a representative sample and is fair?

 

[Feli]

Huh? We are not the "non-surgical board". We are the American Board of Podiatric Medicine...

Perhaps one could (should) re-read the emailed and published responses from the APMA, ACFAS, ABFAS and other podiatry orgs regarding the ABPM proposal of CAQ in surgery?

It was a lot more clear-cut when there were PPMR, POR, etc programs. Now, with all 3yr PM&S and PSR models, the training all appears similar at first glance. Grads have their choice of boards, and that's good (although "choice" is very typically made by which they can pass). Be that what it is, I'm not sure that's a chance for ABPM to jump into a podiatry surgery testing niche that is already filled, as echoed by every response from recognized podiatry organizations that I've come across. The concerns of duplication of something we already have, confusion of hospitals, confusion of public are not just me talking. It's the profession's consensus:

"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 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.
In light of these concerns, APMA consulted with the Council on Podiatric Medical Education. While ABPM notes that CAQs are not recognized by CPME, CPME does have oversight of the boards through its Specialty Board Recognition Committee (SBRC). CPME issued a statement on August 11 requesting that specialty boards "refrain from implementing CAQs, including the CAQ in podiatric surgery," until CPME has an opportunity to complete the planned rewrite of its SBRC documents. APMA supports CPME's statement and its request for delayed implementation. ..."

As much as you say "we" "we" "we" in your posts here and email blasts, I think others within ABPM must realize this CAQ surgery idea is far outside the historical lane and description and mission of ABPM/ABPOPPM. The obvious reason it doesn't involve case review, as ABFAS and every MD surgical board does, is because ABPM doesn't have the structure to support such..

 

[de Ribas]

Huh? We are not the "non-surgical board". We are the American Board of Podiatric Medicine and we offer multiple independently-validated examinations. One of those examinations is the ABPM Certification Exam which is the recognized exam by CPME for podiatric orthopaedics and primary podiatric medicine.

Also we're all DPMs, we're not DPSs.


First, that's not all one must do to be eligible, explained below. Second, I'm always open to suggestions. So please, tell me how to create a psychometrically-valid, objective assessment of one's surgical knowledge or ability? We've been through this with psychometrists over-and-over.

ABPM actually used to require case documentation for its certification exam. Our external psychometrists (who are the same for many boards, BTW) told us it was impossible to make those assessment objective. And then we decided to separately evaluate them and we found that cases made little difference in the overall pass rate. Therefore, if it's a subjective measure and makes little to no difference, why do it? Except to gate keep. Furthermore, it was the biggest liability for the ABPM (and I'll argue any certifying board, because it will be why a board gets sued. They won't get sued over a validated multiple choice question.

If you want to take this one step further and say, yes, but you must evaluate someones skill, not just their knowledge, for them to do surgery. There are already skills assessments in place ... also subjective, but they are there.
1. The skills assessment in residency training (which could be improved and do you know who tried to improve it at the CPME 320 rewrite ... we did!)
2. The privileging process. Both in the initial granting of privileges and continued privileges. It is when you can have direct observation by a peer and if you have too many failures or infections, the system is supposed to re-review.


Totally false. The CAQ is not a demonstration of minimal competence. That is a licensing exam. You have to be first licensed and board certified before you sit for a CAQ. You've already met minimal competence.

And you have to have surgical privileges in addition to primary board certification in order to be eligible to sit for the CAQ in PS. You must continue to demonstrate those surgical privileges. If you lose your privileges, your CAQ in PS is revoked.

And you like to point out the Pathway 1 which is only for those who finished their residency within the past 3 years. Already we've established in many posts that everyone thinks you're competent to do surgery then, the other board, hospitals, governments, peers, etc. Because if you weren't competent, why would you get granted surgical privileges? Do you think you get privileges to independently "practice" on people and complete your Jedi training? The real answer is that you have proximity to your training and the volume of cases you were required to do by CPME is considered sufficient. Even the CMS requirements which state that clinical privileges must be based on a provider's education, training, and experience, is further clarified as current experience. That is defined as the last 24 months of surgical activity.

We recognize that in Pathway 1. (We chose 3 years instead of 2 based on the timing of the CAQ exams in March and that is not a full year from when you finish residency in July, so we thought is was more fair to be 3 years - which is really 2 years and 8 months).

In Pathway 2, if you are more than 3 years out, you must demonstrate your current experience by a case documentation process. How many cases should you submit? You tell me? It doesn't mean those are the only cases you've performed. It's a representative sample of your surgical work in a diversity of categories. How many is fair to demonstrate that? Please, and I'm not being sarcastic, tell me how many is a representative sample and is fair?

I agree and it makes perfect sense. Education, training and experience should determine someone's privileges and ability to practice. Not boards. Boards can only verify, attest, confirm that one's education, training and experience are proficient.

What doesn't make sense to me is that ABFAS apparently works close with CPME. But why then CPME standards for residency training are much lower than the one ABFAS has? If CPME standards of a good surgeon align with ABFAS why less than 50% are trained well enough to reach BC? Just doesn't make sense.

 

[diabeticfootdr]

What doesn't make sense to me is that ABFAS apparently works close with CPME. But why then CPME standards for residency training are much lower than the one ABFAS has? If CPME standards of a good surgeon align with ABFAS why less than 50% are trained well enough to reach BC? Just doesn't make sense.

That’s kind of a … BINGO!

The boards are “major stakeholders” (CPME language) in residency training standards.