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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
Other messages in this thread:
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
08/11/2020 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
08/10/2020 Martin M Pressman, DPM
Questions to the ABPM BOD (Charles M Lombardi, DPM)
I have been reading with great interest the back and forth of some of our finest thought leaders and I think they all have valid points. However, I think the there are broader issues that need to be addressed. Here are some facts: 1. Hospitals are free to grant privileges based on individual training , experience and competency with or without board certification. 2. CPME and JCRSB recognize only one SURGICAL board for podiatrists...ABFAS. 3. ABPM is not the surgical board for podiatry.
If you do not agree with these statements then this discussion is over!
If you are reading this then you have accepted the above statements as the true. The questions that get to the essence of this debate do not need to address any individual or the three year program from whence they came. All programs have differences between them. The programs are inspected and approved .There is really one issue that stands out for me and that is this: Is it fraudulent to represent to a hospital credentialing committee that your ABPM certification is evidence that you are “board certified “ for the surgical privileges requested? This is different than the question of your training, experience ,and competency. Yes, you did a 3 year training program that had surgical training and for whatever reason you chose to be certified by our non-surgical board.
If you represent to an unknowing credentials committee that requires board certification for surgical privileges that you are “ Board certified” and you know that your board certification is not in surgery, you have committed an act of omission . You have not told the truth and have benefited by this omission. This by definition is fraud.
If the hospital does not require board certification, or they are fine with your training regardless of the board certification so be it. None of this argument negates the training received by ABPM certified Podiatrists, but misrepresenting that certification as a surgical certification is fraudulent. If the hospital requires Board certification for surgical privileges and you fail to be honest with respect to your ABPM certification, I’m sorry but that is fraudulent.
Fraud is like pornography, you know it when you see it.
Martin M Pressman, DPM, Milford, CT
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
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