08/16/2022 Allen Jacobs, DPM
ABFAS vs. ABPM (Jeffrey Kass, DPM)
The suggestion that all 3-year residencies provide
an equal surgical experience is simply not true.
There are differences in training, ability, or the
desire to perform advanced surgical procedures of
the foot and ankle among individuals within the
same residency programs. Many, but not all, of the
residency and fellowship graduates in podiatry are
extraordinarily capable. It is one thing to perform
skin and nail surgery, uncomplicated hammer toe
surgery, “lump and bump” surgery. It is quite
another to perform TARs, treat complex ankle
fractures, perform Charcot’s joint deformity
reconstruction, manage a pilon fracture, utilized
advanced orthoplastic techniques.
These, Dr. Kass, are the reasons that legitimate
board certification in surgery is necessary. Not
all podiatrists, 3-year residency or not, are
created equally. There is no perfect certification
process. However, with that understanding, and
knowing that a podiatrist may be charged with the
evaluation and management of complex pathology,
some mechanism should be in place as a reference
point for the public and credentialing bodies to,
as best as possible, that an individual seeking to
provide such care has subjected themselves for
evaluation by their peers, who therefore will
attest to their proven capabilities.
My focus on this debate may differ from most. It is
my belief that the MEDICINE portion of PMSR is
largely ignored in residency training. There is in
my opinion too much emphasis on “podiatric surgery”
(ie-foot and ankle surgery for those of you who
find the term podiatrist uncomfortable). I recently
saw a web posting by a new first year student at
Kent State proudly announcing that he is now on his
way to becoming a surgeon. Not a podiatrist. A
surgeon.
I believe we must revitalize primary care podiatry.
It is fun. I is needed. It is rewarding is all
meanings of the word. Residents spend their time
going from OR to OR, ASC to ASC. We need to upgrade
training and exposure in primary care podiatry. My
least profitable day each week in my day in the OR.
Frankly, as I have aged, I enjoy my office care
more and more. Every week is a bit of vascular
disease, rheumatology, dermatology, gait analysis,
fall risk evaluation, non-operative orthopedics,
radiology, pediatrics, geriatrics, neurology, wound
care, physical therapy.
Students and residents should be assigned to the
offices of representative and successful primary
care podiatry practitioners (how’s that for
psychotic alliteration). We need to stop the
charade that we are somehow equivalent to the MD
model. I for one believe that we should align more
with the dental or veterinary model. Define what
surgical procedures a primary care podiatrist
should be expected to be capable of performing.
Leave the triple arthrodesis, PER IV fractures,
calcaneal fractures, TTC arthrodesis to the
surgeons. Where do we draw that line? We need to
discuss this. The single 3 year PMSR is 90% S and
10% M.
Think about it. Most honest educators (and
students) will tell you the college clinics are
somewhat weak in terms of pathology seen. Third and
fourth year spend a great deal of time on hospital
rotation, where they see surgery and disease
critical enough to warrant hospitalization. The see
a strong ACFAS, and not to be insulting but
realistically a ACPM three steps down from this.
They see state and regional seminars with large
sessions covering surgery related topics, while
medical topics are restricted to corporate
sponsored infomercials. It is the reality of what
our profession has become.
In my opinion, medicine associations and boards
have no authority to confer ANY recognition of
surgical competency. The recent announced position
papers of ABFAS, CPME, ACFAS, I believe support
this position. The profession, in order to maintain
any semblance of credibility and trust, must reject
the suggested CAQ in surgery proposed by the ABPM.
Instead, we should increase education and build
prestige in primary care podiatry.
Allen Jacobs, DPM, St. Louis, MO
