10/03/2022    Martin M Pressman, DPM

ACPM Statement on Board Certification (Timothy Ford, DPM)

I have been involved at all levels of training in
podiatry. Starting with full time teaching at
TUSPM, residency training for 47 years , committee
work for ABFAS on all examination levels. I was
part of the team that developed CBPS, and remain
on the Case review committee for my final year. I
was also chairman of my state board in Connecticut
for 40 years. I am part of the residency training
program at Yale and was Section chief of podiatry
in the department of orthopedics, at Yale School
of Medicine 1997-2017 until we became a department
at Yale New Haven Hospital with a full time
department chair. I say all this to allow you to
understand my perspective on this critical issue
in Podiatry.

I have read Drs. Oloff, Jacobs (both friends) and
Dr. Ford (Well respected) on this issue and all
make salient points. I would like to add to the
discussion with some other critical observations.
#1. It is the licensing examination that sets the
“minimal competency level “to practice podiatry in
any state. (CT has no residency requirement) Board
certification is at a higher level. The definition
states “minimal competency” but this is at the
level the certifying board sets and that is
generally a higher level than licensure.

#2 Hospitals grant privileges based on individual
training, experience and competency. They use
certification status (eligible,qualified,
certified) to help judge competency. They use case
logs and letters of recommendation to determine
training and experience. Most hospitals require
surgeons to become certified by an approved
certifying board to maintain any privileges
granted at the start of a career. I am unaware of
any ABMS medical board that issues a CAQ in
surgery. ABFAS split foot from rearfoot
examinations to accommodate those competent
surgeons who chose not to do or are constrained
by state statute and don't do reconstructive rear
foot/ankle surgery. Those residency-trained
competent foot surgeons can take the foot exam
given by ABFAS which includes case review of their
cases chosen by the board not them.

#3 A CAQ in surgery given by our medical board
(ABPM) does not serve the profession well. It is
not a CPME approved certificate. It is, however,
given by a CPME approved board. That is confusing
on its’ face. Is presenting a non-approved
credential to obtain privileges ethical? Is
conflating certification by the non surgical board
plus a CAQ in Surgery as “board certified with
surgery added” an ethical representation to a
credentialing committee? I think not. If a
hospital accepts ABPM plus case logs and letters
of recommendation that is their prerogative. If,
however, a hospital requires board certification
for surgeons, then the recognized surgery board is
the ABFAS, not ABPM.

#4 Not every person who becomes a podiatrist with
3 years of residency training has the psychomotor
skills, temperament, or ability to become a
competent surgeon. Those that have the desire but
not the ability to perform surgery cannot pass a
rigorous exam with case review including
indications, case management and outcomes analysis
. Taking a multiple choice test can not
differentiate competency. Competency is also a
moving target. Medical conditions, mental illness,
vision, etc. can all affect competency starting
the day after you take an exam. Ongoing evaluation
by MOC, or longitudinal testing, visual
/psychomotor testing are all important.

#5 Board certification sets a bar and a cutoff
between levels of competency. This occurs at the
board qualified/eligible level. This is generally
before or at the beginning of a surgeon’s
practice. This serves the public interest and
safety early on in a surgeon's career. State board
activity is always after the fact. Licenses are
removed for incompetence or other infractions
after harm has occurred. This helps public safety,
but it is always late to the scene.

For all these reasons and more I implore those of
you who have the duty to enforce the CPME rules
and regulations to do exactly that. The
organization that approves specialty boards in
Podiatry (CPME) needs to act and bring ABPM back
into compliance. The calls for one board are heard
and acknowledged. There are only two recognized
board in Podiatry: one of them(ABPM) has flaunted
the rules and ignored all other recognized
interveners, e.g. APMA, AACPM, ACFAS, ABFAS. If
there ever is one board I would assume it would be
the one that scrupulously follows the rules.

Martin M Pressman, DPM, Milford, CT

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