08/21/2020 Charles Lombardi, DPM, Bryan C. Markinson, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
The following is a joint statement by Drs.
Charles Lombardi and Bryan Markinson in the
aftermath of Dr. Lombardi's reaction to the
ABPM BOD position on certification/hospital
credentialing posted in PM News, which resulted
in some unproductive discourse and
misunderstanding. Although this statement is
most germane to what is happening currently in
New York State, we believe it applies
universally across the country.
In the past two weeks, much discussion posted
on PM News once again focused on the
inconsistent practice acts for podiatry across
the United States that caused historical
controversies to surface once again. Of course
these issues represent the frustrations of
having training and then being restricted by
one’s own state practice scope from doing what
they are competent to do. Overlaying that is
the perception by many that we internally as a
profession do not support one another in a
united fashion, separating us into the haves
and have nots. It is undeniable that
historically this has been true, starting with
all of the growing pains of board
certification, the gatekeeper insurance
participation debacle of the 1990’s, and the
advancing questions of which podiatrists should
have active staff operating privileges in
hospitals. The fact that advancement and
positive growth has had some unintended
negative consequences should not be unexpected
and is certainly not unique to podiatric
medicine and surgery.
However, we have now a three to four year
residency training algorithm, and while
imperfect, goes a long way to give all a
standardized post graduate training experience.
At the culmination of that, all graduates have
access to the certification process by the ABPM
and the ABFAS. We recognize that differing
professional training experiences, goals, and
circumstances dictate anyone’s particular path
and what kind of practice life they will
ultimately enjoy.
We believe that any DPM representing that he or
she is board qualified/certified in foot and
ankle surgery should be active in or have
achieved certification via the ABFAS
certification process. We believe that any DPM
representing that he or she is certified in
podiatric medicine should be active in or have
achieved certification via the ABPM
certification process.
We recognize that circumstances exist where
someone has not become certified or qualified
in surgery via the ABFAS process while still
possessing quality surgical skills and who can
document those skills and their case volume.
In those cases, we agree that all factors in
the candidate's background should be used to
determine if they should be granted a
commensurate level of surgical privileges. In
other words, one's certification status should
not be the sole determinate when granting
surgical privileges.
Although the certification process by ABPM
certainly includes training in foot and ankle
surgery, and that granting of surgical
privileges should be according to their
documented training and experience as stated
above, we also believe that no hospital
credentialing process should be confused by any
applicant asserting that such certification is
in foot and ankle surgery.
We believe this to be an inclusive, fair, and a
workable position that can help us move forward
in a united fashion.
We all must realize however, that legislators
(in addition to input from the professions) are
also involved in the process that will
ultimately give rise to any practice act or
modification to a practice act. This also
creates obstacles that are external to our own
actions and desires. We also believe that any
DPM involved in this process must fundamentally
have the goal of fairness to all their
colleagues.
Charles Lombardi, DPM, Bryan C. Markinson, DPM
08/13/2020 Christian A. Robertozzi, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
The posts on hospital privileging have valid
points on both sides. There is a perspective
that has been touched upon but its authority
and influence are not being fully appreciated.
That is the viewpoint from each hospital’s
credentials committee. The purpose of the
committee’s existence is to make sure that
physicians get privileges only for what they
are capable of doing.
For the last 3 years, I have sat on my
hospital’s credentials committee (Newton
Medical Center, Atlantic Health System). The
hospital as well as the entire system are Joint
Commission approved facilities. In order to
maintain Joint Commission approval, the
hospital must follow the protocols as set out
by the Joint Commission. Each hospital has the
right to decide who can have privileges and
what they are. Obviously, we follow the Joint
Commission’s guidelines. On that committee
with me are an oncologist, a general surgeon,
the Chief Medical Officer (who is a
cardiologist) and two pediatricians.
We evaluate every physician who applies for any
privilege at the hospital. Each physician must
demonstrate by logs their education, training
and experience. The hospital gives each
physician 5 years to get board certified or
they lose their privileges. For allopathic
medicine, it must be an American Board of
Medical Specialties board. For podiatry, it
must be either ABFAS or ABPM.
As stated in the posts, the training is not
consistent from one podiatric residency program
to the next despite th fact that they are all
at least three years. The same is true in
medicine. When a general surgeon or an
orthopedist applies for privileges, we make
sure that he has done an adequate amount of
cases for the procedures requested, especially
if they are listed as specialty privileges
(privileges at my institution that are not part
of the core residency training for that
particular specialty).
The second part of the credentialing process
that the Joint Commission requires is called a
focused professional practice evaluation
(FPPE). Each hospital has the right to set its
own numbers for this assessment. Each physician
including medicine, must be evaluated for their
first predetermined number of cases by those on
staff to see if they are qualified to perform
the privileges that they requested.
Each physician gets an FPPE done with each re-
credentialing cycle, usually every two years.
This time it contains complaints by staff,
patients or other physicians. Also, their
malpractice history is part of the review
process. If you have followed the rules and
done everything as per protocol, you may not
even know that this is going on. On the other
hand, if you have raised a red flag, you have
been spoken to about the issue.
Also, you have an unfavorable FPPE report in
your file. Yes, we have standardized the
residency training to a certain degree.
However, I don’t believe we will ever see a
time when everyone will be able to sit forthe
surgical boards. The reasons are simple. Some
of our colleagues don’t want that type of
practice. Others, may not be able to get the
diversity or number of cases that are needed to
sit in the allotted time frame.
Nevertheless, they are good surgeons. They had
good residency training. Their surgical
privileges should be based on their education,
training and experience by documenting the
cases that they have done as a surgeon. If they
are fresh out of their residency program, they
must produce their residency logs. Just because
they are applying for privileges, doesn’t mean
that they get the full scope that the hospital
allows for podiatry.
We have cardiologists who insert pacemakers.
They are boarded in cardiology (a medicine
board not a surgical board) which doesn’t
include inserting pacemakers. They have to show
that they have had training and experience
inserting pacemakers. They have someone
evaluate their first few cases to assure that
they know what they are doing. The cardiologist
is boarded in medicine but has limited surgical
privileges.
Podiatry has made significant strides over the
past few decades. We went from fighting for
hospital privileges to being fully incorporated
into the medical staff in most of the country.
One of the main reasons for this is that
podiatry changed its academic and residency
training to a model that mimics allopathic and
osteopathic medicine. Our three-year minimum
required residency training is the same as
medicine. With podiatry’s track record of
success being our mirroring our medicine
colleagues, it makes sense to continue to
travel down that road to garner continued
successes.
Christian A. Robertozzi, DPM, Newton, NJ
08/11/2020 Michael Loshigian, DPM
RE: Questions to the ABPM BOD (Charles M Lombardi, DPM)
It is certainly interesting to see the charged
and emotional responses to Dr. Lombardi's
inquiry from several of our profession's most
influential members. Before you allow
yourselves to be "triggered" and attack Dr.
Lombardi I would encourage all of you who feel
that the inquiry is controversial, unfair, or
dividing our profession to take a moment and
reread his post.
The first part of his inquiry simply states
that the ABPM is spending money to help a
member get hospital privileges and that his
hospitals allow ABPM certified people to have
hospital privileges that include admitting
patients and perform wound care, etc. The
"etc." implies they are credentialed to do more
than wound care. "but not surgical privileges"
implies OR privileges. "my hospitals" does not
imply that he personally owns the hospitals and
therefore has sole discretion in dictating
hospital credentialing policy. In fact, at his
hospital podiatry is a division of the
orthopedic surgery department so the chair of
orthopedic surgery and the hospital board via
the hospital by-laws determine the
credentialing process for podiatry and all
other disciplines as well.
The second part of his inquiry is a simple
question to the ABPM BOD. Straight forward, no
subtext or insinuation, just a question.
He then states that he has had inquiries from
his residents about ABPM certification and its
implications for hospital surgery
credentialing. He asks the ABPM BOD to clarify
their position and justify how their
certification is valid for ensuring that their
members have achieved a level of surgical
competence deserving of hospital credentialing
to do so.
As an aside, why would some people question
whether or not Dr. Lombardi is being honest or
truthful in saying that some of his residents
inquired or expressed concern about the
subject? I have known Dr. Lombardi for more
than twenty five years and have never seen a
reason for anyone to question his integrity,
nor his love and dedication to our profession.
The pathway to certification by the ABFAS is
difficult and time consuming. It requires that
its members have not only had the training to
perform a variety of surgical procedures but
that they have actually performed them on their
own patients. It ensures that a candidate's
decision making process, procedure planning and
rationale, technical performance, and post op
care all meet the standards of care that are
accepted in the surgical community. Surgical
cases need to be submitted, peer reviewed, and
accepted by experienced board certified
surgeons.
The three year podiatry residency we have today
provides an experience that should fulfill the
basic training needs for graduates to go
forward in their careers in a competent manner.
It by itself does not ensure to a hospital or
the public the same level of surgical
competence and experience as an ABFAS certified
surgeon. Some programs struggle to meet their
minimum surgical case requirements while others
routinely provide a surgical experience of
three times the minimum requirements. There is
no arguing the fact that there still remains a
spectrum of training experiences in podiatric
residency education.
As I understand their process, the ABPM
certification can be achieved without ever
actually treating a single patient, let alone
performing a surgical procedure. The
prerequisites for taking the qualification and
certification examinations are to simply
graduate residency and have a licence to
practice podiatry.
I graduated from a PSR-24 residency in 1995. It
was the most sought after residency and the
pinnacle of podiatry training of that time. Our
residency programs have come a long way since
then. Despite our progress in training, there
is still no other surgical discipline in
medicine that requires less than five years to
complete. All of those disciplines require
actually performing surgery after residency to
achieve board certification.
According to the ABPM website there is no
mention of consideration for surgical
competence.
"ABPM Goal and Objectives:
Goal: To protect the health and welfare of the
public through an ongoing process of evaluation
and certification of the competence of
podiatrists in the specialty of Podiatric
Orthopedics and Primary Podiatric Medicine."
How is it that Dr. Rogers, Dr. Scartozzi, Dr.
Ribotsky, and Dr. Markinson contend that ABPM
certification is a credential to be used by
hospitals in the surgical credentialing
process? Are the ABPM BOD willing to take
personal responsibility for the surgical
competence of their members? I would expect
that they will not.
We all know that most hospitals credential
podiatry surgical privileges in a tiered system
of complexity. Most will grant all licensed
podiatrists level 1 privileges without board
certification or even qualification for that
matter.
Hospital staff privileges, sure I can stand
behind that. A basis for surgical
credentialing? Why even argue the point? This
is not elitist or exclusionary or divisive. Dr.
Lombardi simply made an inquiry. Why be
defensive and launch an attack on his motives?
Answer the question. If you don't like your own
answer, take a look in the mirror.
Michael Loshigian, DPM, Fresh Meadows, NY
08/08/2020 Bryan C. Markinson, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
Firstly, I consider Drs. Charles Lombardi and
Allen Jacobs my professional friends for many
years. They have both treated me with
tremendous respect which is mutual. I view both
of them as esteemed members of our profession,
and I am thankful for what they have done
publicly in our behalf to elevate our
profession. Their professional lives are
largely involved with mentorship. Most
importantly, I would have any member of my
family treated by them without hesitation.
They have both historically posted statements
in this forum I have found patently outrageous,
but sarcasm never offends me and occasional
self-serving posts don’t usually offend me.
Dr. Lombardi, on August 3rd, asks what we may
feel about his proclamation that ABPM certified
(or really, non-surgical certified) podiatrists
do not need and should not be granted surgical
privileges in hospitals. Some may react with
disdain, even disbelief at his directness. In
view of current trends, certainly in about ten
years, it may very well be that his vision will
be the norm. Even if we just look at the
present, his proclamation may be just, with
extreme caution, in the majority of cases. In
his latest post, he states matter of factly
that “my hospitals have always allowed ABPM
members to obtain admitting privileges and
wound care, etc., but not surgical privileges”
He ends his post with the claim that these are
his personal questions and do not represent any
organizational affiliations present or past.
Dr. Lombardi has run high powered hospital
based surgical residencies for years and is a
very active player in the current New York
State Practice Act negotiations. It is
therefore a bit of a stretch to assume that his
current queries are not born out of emerging
controversies in both of these activities.
Dr. Jacobs, who essentially agrees with Dr.
Lombardi gives a little more background to the
position and accurately posts that the
attaining of a 3 year surgical training
diploma, indicating equivalent (wink) training
for all of our graduates does not automatically
pre-ordain anyone into being a Dr. Lombardi or
a Dr. Jacobs. Equally, attaining the 3 year
diploma gives no assurance whatsoever that the
holder of such certificate will ever achieve
the numbers and variety of cases to become
surgically certified. And yes, some wayward
sons or daughters (sarcasm) may not actually
demonstrate surgical ability or worse, decide
surgery is not for them and actually choose to
be a non-surgical podiatrist or a LIMITED
surgical podiatrist. But in truth, Dr. Jacobs,
like Dr. Lombardi is correct in that it is
reasonable eventually for hospitals to demand
surgical certification in order to get into an
operating room. He at least asks Dr. Lombardi
if current residents who go thru the three-year
experience have some right to perform surgery
in hospitals if they achieve ABPM certification
only. Dr. Jacobs at least asks, Dr. Lombardi is
positive that they should not.
Whatever the outcome for any particular
resident, we must remind ourselves that
currently every podiatry graduate gets a crack
at the SAME 3 year residency, and ten years
from now all the inequities of post graduate
training opportunity that have plagued the
profession in the past will be dissolved. BUT….
There are still some living and breathing
colleagues of ours that are working, providing
great care, surgical and otherwise, who for a
myriad of reasons have limited surgical
practices and the hospital privileges to
support them. It is both these individuals, as
well as those in training now who will never be
surgically certified that the ABPM seeks to
protect by taking the position that hospital
credentialing and privilege delineation should
not be the domain of framers of any state
podiatry practice act, and absolutely not tied
to any particular board certification. In other
words, to the degree someone can demonstrate
training and competency in neuroma surgery, the
decision to grant that privilege should lie
totally with the hospital. Who would not agree
with this?
In this forum, Dr. Lombardi stated a few years
ago, that podiatrists like me, ABPM certified
only, do not need surgical privileges. I have
never considered myself a surgical podiatrist,
but I did complete some unique training, which
by whatever good graces of the universe, led me
to the path where I gained extensive experience
in dealing with soft tissue and skin tumors of
the foot. That experience included being
mentored by globally prominent oncology
surgeons and pathologists. I am part of a
multispecialty team that now counts on me to be
there. I will never fix an ankle. Never do a
Lapidus. Don’t know a STAR from a Salto. But a
couple of times a month I am doing some surgery
with potentially very serious survival and
functional implications. Yeah, that requires an
OR. The ABPM supports my right to demonstrate
my experience; my hospital to decide if its
credible; and perform to that level; and to
stop my own practice act from taking that away
from me. Of course, there are many like me, and
as I indicated there always will be.
Lastly, Dr. Lombardi states that his RESIDENTS
may be asking that if ABPM believes that an
ABPM certified person should be given surgical
privileges, how can they claim that their
Diplomates are trained and evaluated in
surgical skill sets without any methodology in
their testing? First of all, I sincerely doubt
that anyone at the residency level would ever
ask this question. Why wouldn’t resident A,
aspiring to be the next Lombardi and resident
B, aspiring to be the next Markinson, support
each other to achieve as they see fit and
comfortable. Why would resident A seek to block
his colleague B from entering an OR in a
hospital because he or she seeks to limit his
surgery to what he feels qualified to do or
eventually learns to do and can demonstrate
competency. This is what the ABPM seeks to
defend. And at the crux of this whole
controversy is the fact that even though I have
in fellowship and other training have been
exposed to hundreds of soft tissue/skin
procedures on the leg, it is not okay that the
practice act should explicitly exclude me from
doing them because I can’t fix a bi-malleolar
fracture and because ABPM is my only
certification. Actually, that is worse than the
existing anatomical boundary of the ankle,
which discriminates against no one.
Although I abhor legal battles within our
fraternity, the APBM position makes sense.
Bryan C. Markinson, DPM, NY, NY
08/07/2020 Bryan C. Markinson, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
I consider Drs. Charles Lombardi and Allen
Jacobs my professional friends for many years.
They have both treated me with tremendous
respect which is mutual. I view both of them as
esteemed members of our profession, and I am
thankful for what they have done publicly in
our behalf to elevate our profession. Their
professional lives are largely involved with
mentorship. Most importantly, I would have any
member of my family treated by them without
hesitation. They have both historically posted
statements in this forum I have found patently
outrageous, but sarcasm never offends me and
occasional self-serving posts don’t usually
offend me.
Dr. Lombardi, on August 3rd, asks what we may
feel about his proclamation that ABPM certified
(or really, non-surgical certified) podiatrists
do not need and should not be granted surgical
privileges in hospitals. Some may react with
disdain, even disbelief at his directness. In
view of current trends, certainly in about ten
years, it may very well be that his vision will
be the norm. Even if we just look at the
present, his proclamation may be just, with
extreme caution, in the majority of cases.
In his latest post, he states matter of factly
that “my hospitals have always allowed ABPM
members to obtain admitting privileges and
wound care, etc., but not surgical privileges”
He ends his post with the claim that these are
his personal questions and do not represent any
organizational affiliations present or past.
Dr. Lombardi has run high powered hospital
based surgical residencies for years and is a
very active player in the current New York
State Practice Act negotiations. It is
therefore a bit of a stretch to assume that his
current queries are not born out of emerging
controversies in both of these activities.
Dr. Jacobs, who essentially agrees with Dr.
Lombardi gives a little more background to the
position and accurately posts that the
attaining of a 3 year surgical training
diploma, indicating equivalent (wink) training
for all of our graduates does not automatically
pre-ordain anyone into being a Dr. Lombardi or
a Dr. Jacobs. Equally, attaining the 3 year
diploma gives no assurance whatsoever that the
holder of such certificate will ever achieve
the numbers and variety of cases to become
surgically certified. And yes, some wayward
sons or daughters (sarcasm) may not actually
demonstrate surgical ability or worse, decide
surgery is not for them and actually choose to
be a non-surgical podiatrist or a LIMITED
surgical podiatrist. But in truth, Dr. Jacobs,
like Dr. Lombardi is correct in that it is
reasonable eventually for hospitals to demand
surgical certification in order to get into an
operating room. He at least asks Dr. Lombardi
if current residents who go thru the three-year
experience have some right to perform surgery
in hospitals if they achieve ABPM certification
only. Dr. Jacobs at least asks, Dr. Lombardi is
positive that they should not.
Whatever the outcome for any particular
resident, we must remind ourselves that
currently every podiatry graduate gets a crack
at the SAME 3 year residency, and ten years
from now all the inequities of post graduate
training opportunity that have plagued the
profession in the past will be dissolved. BUT….
There are still some living and breathing
colleagues of ours that are working, providing
great care, surgical and otherwise, who for a
myriad of reasons have limited surgical
practices, and the hospital privileges to
support them. It is these individuals, as well
as those in training now who will never be
surgically certified that the ABPM seeks to
protect by taking the position that hospital
credentialing and privilege delineation should
not be the domain of framers of any state
podiatry practice act, and absolutely not tied
to any particular board certification. In other
words, to the degree someone can demonstrate
training and competency in neuroma surgery, the
decision to grant that privilege should lie
totally with the hospital. Who would not agree
with this?
In this forum, Dr. Lombardi stated a few years
ago, that podiatrists like me, ABPM certified
only, do not need surgical privileges. I have
never considered myself a surgical podiatrist,
but I did complete some unique training, which
by whatever good graces of the universe, led me
to the path where I gained extensive experience
in dealing with soft tissue and skin tumors of
the foot. That experience included being
mentored by globally prominent oncology
surgeons and pathologists. I am part of a
multi-specialty team that now counts on me to
be there. I will never fix an ankle. Never do a
Lapidus. Don’t know a STAR from a Salto. But a
couple of times a month I am doing some surgery
with potentially very serious survival and
functional implications. Yeah, that requires an
OR. The ABPM supports my right to demonstrate
my experience; my hospital to decide if its
credible; and perform to that level; and to
stop my own practice act from taking that away
from me. Of course, there are many like me, and
as I indicated there always will be.
Lastly, Dr. Lombardi states that his RESIDENTS
may be asking that if ABPM believes that an
ABPM certified person should be given surgical
privileges, how can they claim that their
Diplomates are trained and evaluated in
surgical skill sets without any methodology in
their testing? First of all, I sincerely doubt
that anyone at the residency level would ever
ask this question. Why wouldn’t resident A,
aspiring to be the next Lombardi and resident
B, aspiring to be the next Markinson, support
each other to achieve as they see fit and
comfortable. Why would resident A seek to block
his colleague B from entering an OR in a
hospital because he or she seeks to limit his
surgery to what he feels qualified to do or
eventually learns to do and can demonstrate
competency. This is what the ABPM seeks to
defend. And at the crux of this whole
controversy is the fact that even though I have
in fellowship and other training have been
exposed to hundreds of soft tissue/skin
procedures on the leg, it is not OK that the
practice act should explicitly exclude me from
doing them because I can’t fix a bi-malleolar
fracture and because ABPM is my only
certification. Actually, that is worse than the
existing anatomical boundary of the ankle,
which discriminates against no one.
Although I abhor legal battles within our
fraternity, the APBM position makes sense.
Bryan C. Markinson, DPM, NY, NY
08/07/2020 Bret M. Ribotsky, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
It seems that the “common nerve” has been
pressed once again: surgery vs. non-surgery,
and today there is no 4% elixir that we can
inject for a cure. It returns us to the primal
podiatric question: Who are we? Seeking this
answer has been what the past 35+ years has
been all about. We have had expensive
comprehensive projects, The Selden Report,
Project 2000 and many, many more seeking the
answer. This has been the question since my
first day in podiatry school in 1984.
Back then, the top of the class became
surgeons, and the rest just were left out.
While Allen, Charlie, and the many other great
contributors to our profession have pointed out
that all training is important, it should be
clear that most great leaders strived for
certification in every boards they could. At a
great cost in money and time, driven to be the
best we could be, many of us became certified
in orthopedics, medicine, and surgery. Then a
change stirred from the grass roots developed.
We are all podiatrists and for the MD/DO world
to know us we needed to become more uniformly
trained. This began with the medical board
(ABPM) merging with Orthopedics (ABPO) to
become ABPOPPM. The surgical board added MIS
certified members (after the lawsuit) then
added the ankle, all while the major stake
holders worked to remove all this confusion.
We are so close now. Just one more merger to
get it all as one. Since all residencies are
three years, it’s time for surgery and medicine
to become one, to merge. Maybe call it the
American Board Podiatry or whatever name is
chosen. This evolved board will test;
functional biomechanics, foot and lower
extremity surgery, and general lower extremity
medicine. Those with this certification will
hold their heads up high, as the true total
expert in care of the lower extremity.
And the long road that has been under
construction for all these years will be
completed. Those of us who traveled many miles
on this road will sit back and cheer as the
future of our profession will have overcome its
greatest obstacle - ourselves. Of course we
could just get the MD degree.
Bret M. Ribotsky, DPM, Boca Raton, FL
08/06/2020 Richard M. Maleski DPM, RPh
Questions to the ABPM BOD (Charles M Lombardi, DPM)
My question is not to the ABPM BOD, but to the
graduating residents. Why not take the ABFAS
certification test? If you want to have
surgical privileges, then get board certified
by our profession's surgery board! This really
shouldn't be a question of who is qualified to
do a particular procedure. There are many DPM's
in my generation who, like me have been
involved in residency training, residency
genesis, hospital privileging, and opening up
hospitals to podiatrists for surgery.
Doing these things requires a thought process
that needs to consider the overall well-being
of the patients, the community, the individual
podiatrists, the hospitals involved, even the
hospital administration. It's just not the
podiatrist or the podiatry profession. There is
a responsibility to all of these when one is
advocating for an individual or a group to gain
the privilege of treating patients, whether by
surgical of non-surgical means.
In my dealings with hospital administrators and
other physicians concerning privileging, I have
found that everyone expects there to be a
consistency in documented training and
documented testing. Everyone knows that this is
not a perfect system. Everyone knows that
different residency programs will provide
different levels of training, but there must be
a minimal standard of training to allow for
what the medical community and society in
general deems to be adequate. And there must be
testing to "validate" that the individual
physician has met those requirements.
This is not unique to podiatry. This is a
common thread throughout medicine. Each
individual physician is going to have different
abilities, different levels of accountability,
compassion, etc.; and these are hard to
quantify, but the number of procedures
performed, patients treated can be quantified.
And thus being able to demonstrate mastery of
the knowledge necessary to perform those
procedures and treat those patients can also be
quantified through testing, i.e. board
certification. This is the path that society
has chosen for those who wish to pursue this
career, whether it be podiatry, medicine or
osteopathic medicine. It is not perfect, but
how else can a committee decide who is and who
is not qualified to do surgery?
I am certified by both ABFAS and ABPM. I am a
residency program reviewer for ABPM. I think
there is definite value in the ABPM
certification, and what ABPM is doing to ensure
that residents coming out of their programs
have adequate training in non-surgical aspects
of podiatry. I encourage our residents to
obtain both ABFAS and ABPM certifications.
However, if that person is going to be doing
surgery in an institution, then they should
carry the ABFAS certification.
Why give a plaintiff's attorney, an orthopedist
or orthopedic society, hospital administrator
or hospital attorney a reason to ask why all
other members of a surgical department are
board certified in their surgical specialty,
when you are not?
Richard M. Maleski DPM, RPh, Pittsburgh, PA
08/05/2020 Allen Jacobs, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
There is very significant clinical experience
heterogeneity within the “three-year”
podiatric residencies. Both surgical and
medical education is variable from program to
program. The completion of a three year
residency in no manner guarantees either
surgical or medical expertise. Therefore, the
board certification process in both medicine
and surgery.
Having been in active practice for greater than
40 years, and having participated in post
graduate education, residency training,
reviewing malpractice claims, and my activity
as an ABFAS examiner, I should like to suggest
the following for consideration.
The DPM degree carries many trusted
responsibilities to the public, the state,
health care entities, and to fellow
practitioners. The DPM degree confers a trust.
This trust includes the determination of
qualifications for board certification in
medicine as well as surgery. A podiatrist
struggling to perform an Austin bunionectomy
for two hours simply does not belong in an
operating room performing such procedures.
There is a major difference in peri-operative
judgment and quality of surgical care between
those completing a rigorous surgical program
and those who have not. That is an absolute
fact. Podiatric surgery today includes total
ankle arthropasty of fusion, pilon and ankle
fracture management, Charcot’s joint surgery.
The podiatrist today is caring for surgical
patients who frequently suffer from significant
comorbidities. Rigorous training in surgery
qualifying some but not all to manage patients
with complex medical and surgical pathology is
available for some, but not all. Those who do
not complete such training, as evidenced by a
failure to complete adequate training in
surgery by meeting minimal activity volumes,
and/or failing to qualify for and pass the
surgical board should not be permitted surgical
should be considered for at most limited
delineation of surgical privileges.
To do otherwise is to fail our duty to protect
the public and health care-providing entities.
Credibility and respect for the DPM degree is
based in no small part in the legitimate
credentialing of our colleagues, such that the
DPM degree is trusted to what is ethical and
appropriate.
The proposal that ABPM certified podiatrists
are by definition qualified for surgical
privileges is contrary to the standards of
allopathic medicine. It IS NOT a surgical
board. It is contrary to the safety of the
public. It is contrary to the effective and
safe delivery of health care.
Our profession has a surgical board. It has a
medical board. That is reality. The days of
buckaroo podiatry and Podiatric surgery are in
the past. Many of today’s young residency and
fellowship trained graduates are
extraordinarily well trained. As I reach the
end of my career, I marvel at the abilities and
knowledge of many of our recently trained
podiatrists. Sadly, such training is not
available to all. The 3-year residency does not
provide uniformity of training, particularly
with reference to surgical experience.
The opinion of Dr. Rogers, who I am given to
understand himself did not complete a surgical
residency, may be a populist view for those not
ABFAS certified. And yes, ABFAS is not without
flaws. However, some minimal standards of
expectation of training should be expected from
those asking for hospital surgical privileges.
Removal of a wart or ingrown toenail is one
thing. Placing an IM nail and fixator for a
patellar arthrodesis is quite another.
Allen Jacobs, DPM, St. Louis, MO
08/05/2020 Gino Scartozzi, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
I read Dr. Lombardi's post and somewhat
troubled by a member of the ABPM Executive
Board member would put forth such a position
questioning defending a podiatric physician
from discriminatory practices allegedly for
hospital privileges denied on the basis of
which board is accepted by the hospital. The
APMA has stated its position on this numerous
times regarding hospital privileges and boards
recognized for privileges.
Board certifications in podiatric orthopedics,
podiatric surgery, wound care and other
podiatric subspecialtes should be encouraged.
However, there is a far cry from a "board
certified" physician and the demonstration of
one's clinical abilities, even in the surgical
arena Dr. Lombardi. Do all podiatric surgical
procedures require board certification? A board
certified physician provides "better" care?
Nope ... not always. It is just one of the many
parameters used for evaluating a physician's
abilities. We all know that and have
experienced that as fellow podiatrists and even
as patients in our own medical care at times.
Perhaps Dr. Lombardi would better understand
this? ... A hospital has the right to decline
hospital privileges for surgery since it is
their belief that only "board certified" ABPM
podiatrists have a true understanding of the
biomechanical implications and sequela of
podiatric surgical procedures they perform?
Without that board credentialing, podiatrists
may not do surgery. Would that be a basis of
exclusion?
How about this Dr. Lombardi? A hospital has the
right to decline surgical privileges for
amputation and wound care surgery, unless that
podiatrist was "board certified" in wound care
since only a "wound care expert" can truly
ascertain when surgical intervention is
required. Without that appropriate board
certification, that podiatrist cannot perform
any surgical procedures related to a non-
healing or delayed healing wound. Would that be
a basis for exclusion also?
Perhaps this member can spend better time
advocating for our profession in other ways?
Gino Scartozzi, DPM, New Hyde Park, NY
08/04/2020 Dieter J Fellner, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
Dr. Lombardi's question to the ABPM raises an
interesting point. Such a concern would be
founded, one might assume most assuredly, on a
sound scientific basis. I will be extremely
interested then to see the scientific evidence.
Could it be true that three year residency-
trained ABPM boarded surgical podiatrists fare
so poorly, in the surgical arena, as to be
denied surgical privileges by a hospital. All
of the hard-gained surgical training in a three
year residency, will then amount to nothing.
Can a three year residency trained, and ABFAS
boarded podiatrist outperform his brethren so
magnificently that by that path, AND THAT PATH
ALONE, might a hospital surgical privilege be
granted. Both Podiatrists attended the surgical
residency; could it be true this can be
validated only when supported with additional
paperwork granted by ABFAS but not ABPM. Just
to clarify, there is no additional residency or
fellowship 'training' to provide the paperwork
for the ABFAS boarded individual.
And what of surgical training that is not
provided by ABFAS, There is now an ever
increasing demand for minimally invasive foot
and ankle surgery. This is offered only by the
American Board of Multiple Specialties. Would
this also fail to meet Dr. Lombardi's personal
standards. And if so, why?
I look forward to the learned and objective
scientific citations that might help to clarify
and corroborate Dr. Lombardi's opinion. A
selection of peer reviewed scientific papers
will help to elevate his personal concern,
beyond that of mere personal incredulity.
This will be of great importance. If such
evidence should be lacking, surely then we need
to relegate the individual's personal opinion,
within its proper context. That is to say, it
would need to be largely ignored.
Dieter J Fellner, DPM, NY, NY
