10/11/2022    Joan Oloff, DPM

AACPM Statement on Board Certification

I have been following the thread regarding the
surgical board certification and have a few
observations. It has been noted that several older
doctors have shared passionate feelings about this
topic. This is not an accident. There was limited
hospital privileges early in their careers.
Allopathic physicians had little knowledge of or
respect for the training of podiatrists. The way
to change minds was, and is, through training,
knowledge, and outcomes.

In order to achieve parity, it is, in my opinion,
important to have parity in our board
certification process. There is no surgical MD who
could be board certified through a non-surgical
board. Yes, the bar is high, but it is not higher
than any other surgical specialty in medicine. The
experience gained throughout residency sets the
ground work to build on one’s initial experience
to grow from becoming board qualified to board
certified. This is not unique to podiatry. The
podiatric medicine board provides an important
service to the profession to allow non-surgical
podiatrists to obtain board certification. It
would not serve the profession well to allow this
board to reach beyond its scope and lesson the
requirements for surgical board certification.

Many of the readers on this platform are
advocating for a degree change, from DPM to MD.
These same podiatrists are now requesting we
diminish the requirements for surgical board
certification. This makes no. The privileges we
enjoy today did not drop on us like snowflakes.
They were hard earned, with a lot of blood, sweat,
and tears. With privilege comes responsibility.
As the torch gets passed, I hope we all remember
our history and are proud of how far we’ve come.

As in any family, each generation should build
upon the work of those that came before them.
Taking short cuts may provide several unintended
consequences. Let’s respect and guard these
privileges, lest I fear we may lose them.
Shortcuts never have good long-term outcomes.

Joan Oloff, DPM, Los Gatos, CA

Other messages in this thread:

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10/13/2022    Rod Tomczak, MD, DPM, EdD

AACPM Statement on Board Certification (Joan Oloff, DPM)

I haven't noticed anyone complaining about
completing a podiatric surgical residency and not
being able to achieve board certification in
podiatric medicine. It's only podiatrists who
don't match in a surgical residencies who want to
qualify somehow as board certified podiatric
surgeons. Since 1986 I have been involved with
institutions granting osteopathic or allopathic
degrees to students who go through a match process
similar but not identical to ours. I went through
the first podiatric residency match in 1977 and
this process was supposed to end the early signing
of students into the most desirable programs and
give everyone the opportunity to apply and perhaps
interview for the more attractive surgical
programs if that's what the student wanted.

If a fourth year MD or DO student wants to
eventually become an orthopedic surgeon, he or she
must apply to interview at the programs the
student would like to train with. There is a
screening process based on data all students
submit. There is no guarantee the program will
want to interview that student, so students
usually apply to numerous programs. Students then
interview at programs that think he or she might
make a good resident and both the student and
program subsequently rank each other. There is no
guarantee that any program will match the student
and suddenly the student may not be able to enter
a program leading to board certification in
orthopaedic surgery. Some people consider a
physical medicine and rehabilitation (PM+R)
physician to be a non-operative orthopedist,
similar to a neurologist being a non-operative
neurosurgeon.

The point is that there is no guarantee that every
medical student who wishes to become a board
certified orthopaedic surgeon achieves it and not
every student who wishes to become a PM+R
specialist becomes one. What is certain is that
no PM+R physician can be granted a piece of paper
making them a board certified orthopedic surgeon
nor can an orthopaedic surgeon suddenly become a
PM+R physician. Attend any reputable orthopedic
seminar and you will see PM+R physicians there or
attend a good PM+R program and you will see
orthopedic surgeons in attendance. However, 25
hours of CME credit does not make one a cross
trained board certified anything else. To change
certification, an MD or DO must complete another
residency.

I was lucky enough to match into a PSR 24+ in 1977
taught by the best trainers on the East Coast. I'm
not sure what I would have done had that not been
the case, but I doubt my path in podiatry would
have been what it became. Are there current
graduates who are not able to fulfill their
potential because they have been limited by where
they matched? Some of us remember when ABPS
members were assessed to fight a lawsuit by
minimal incision surgeons over board
certification.

When ABPS board certified podiatrists applied to
hospitals in the early 1980s, we were met with the
response by surgeons that we had "a weak board."
Not that any of them took our board, but I think
they feared economic consequences of competing.
When I got to Ohio State University, I was handed
a single page listing surgical procedures that
included every surgical specialty. I checked one
line. It simply read, "Foot and Ankle." No
neuroma, no tarsal tunnel, no bunion, no internal
or external fixation, no specific ankle fractures.
I was told do what you were trained in and
comfortable with, ask for help if you need it.
There was no economic competition.

Rod Tomczak, MD, DPM, EdD, Columbus, OH

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10/05/2022    Jon Purdy, DPM

AACPM Statement on Board Certification (Bret Ribotsky, DPM)

Board certification, in this day and age, is a
requirement to maintain insurance contracts and
hospital privileges in almost all cases. Unlike
days past, when certification was a badge of honor
and optional, today, not becoming board certified
can mean the end of a physician's practice.

Like any political world, our profession is
intertwined among our state, the APMA and multiple
certification boards. To challenge this,
especially on a state society level, is a
political hot potato. Even individuals appear to
be fearful in using their names in posting
commentary. The APMA, through the HOD, in
conjunction with the CPME, gives the green light
to the boards of their choosing. It then follows
that states will transfer this decision to their
individual licensing boards, and
therefore the acceptance of hospitals and
insurance companies.

Knowing the severity of not becoming certified
should make one question the fairness and
oversight in the administration of such a
certification board. One should know that the
ABFAS (American Board of Foot and Ankle Surgery)
and the ABPM (American Board of Podiatric
Medicine) have "self-certified," and do not
currently have any standardized third party
accreditation or other independent oversight. This
runs contrary to other well know boards such as
the American Board of Orthopaedic Surgery, which
have partnered with the National Center for
Quality Assurance (NCQA) and National Quality
Foundation (NQF).

Many may not be aware of the American Board of
Multiple Specialties in Podiatry (ABMSP). This
board is accredited by the American National
Standards Institute (ANSI) under the ISO
International Standards ANSI/ISO/IEC/17024:2003
for Accreditation for Bodies Operating
Certification of Persons, as well as accredited by
URAC (former Utilization Review Accreditation
Commission). Over the years, the ABMSP has failed
to gain acceptance by the APMA-HOD, even using the
same psychometrically based testing and comparable
certification process as that of the ABFAS. The
American Board of Multiple Specialties in Podiatry
has certification tracks for wound care, diabetic
limb salvage, podiatric medicine, podiatric
orthopedics, and podiatric surgery.

The CPME and the HOD state that numerous boards
are confusing to the public and medical
communities and strive for unification. It follows
that one board certifying in multiple areas would
be preferred, according to this stated mission.
There is no board better qualified nor situated to
fulfill this role than the ABMSP. Yet, they remain
a non-entity in our profession.

In comparison, the ABFAS rules leave podiatrists
terminally ineligible for board certification if
"too much" time has passed in one's career,
effectively ending that individual's career. There
is no such limitation by the ABMSP. If one meets
all criteria to sit for board certification, I
can't for the life of me understand why a
podiatrist would be deemed ineligible secondary to
having "too much" experience.

There are a number of ABFAS "criteria" in becoming
eligible to sit for board certification, that are
far more restrictive than that of even the
American Board of Orthopaedic Surgery. Although
ABMSP does have minimum case numbers needed within
a specific time frame, they do not require “case
diversity” and do not require “site specific”
minimum number of surgeries. This is also true of
the ABOS. These boards do not pose these
requirements, because case diversity and site
specific surgical requirements potentially force
surgeons to operate outside of what works best in
their hands. There is also the potential that
these requirements compel a surgeon to perform
surgeries that are not in the best interest of
their patient population in order to meet
certification requirements.

Currently a podiatrist must join multiple boards,
pay multiple fees, and strain their practice with
multiple burdensome application processes. This
brings to question the current system and
political mechanisms this profession faces.
Although the ABMSP is equipped to solve all of
these extremely important issues and flaws, they
can't seem to beat the system. And to this end,
many of our colleagues will soon face the
inability to continue a viable practice in the
absence of "board
certification."

Jon Purdy, DPM, New Iberia, LA

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09/29/2022     Timothy Ford, DPM

AACPM Statement on Board Certification (Allen Jacobs, DPM)

I would like to address the ongoing issues of CAQ
and the Boards and make some salient points to
clarify many of the statements made. These are my
personal opinions and what I have observed in an
academic setting as well as a residency and
fellowship director:

• Board certification demonstrates minimal
competency it does not demonstrate the fact that
someone excels in any form of surgery or medicine.
In fact, Board Certification tests Minimal
Competency as the definition below states:

o Physicians seeking board certification in a
given area of specialty must successfully complete
and pass an examination process designed to test
their mastery of the minimum knowledge and skills
contained in the core competency document. Prior
to taking the examination, a physician must
graduate with a degree, either MD, DO or DPM and
meet all other prerequisites to certification as
set out by the certifying agency or "board."

• Residents who graduate from any residency
program in orthopedics, general surgery, plastics,
podiatry etc. are granted privileges by the
hospital/facility via their credentialing
committees. Initially only completion of a
residency and or fellowship and case logs (as a
resident/fellow) are the determining factors for
surgical/medical privileges at a hospital or
surgery center not Board Certification! For the
most part those who graduate from a residency
program are immediately able to perform surgical
cases without being out of residency training for
any length of time or supervision. Once graduated
residents are evidently competent enough to now
perform surgical cases on their own.

• Board certification can also lead to an increase
in a physician to perform needlessly more
surgical/medical cases, (to obtain the required
cases for board certification), this too has the
potential as a public and ethical issue that is
never discussed.

• Again, there is confusion relating CAQ in
podiatic surgery to Board Certification which it
is not. The American Board of Podiatric Medicine
has stated this including the requirement to be
Board Certified to sit for their CAQ’s. One other
reason why physicians sit for a Board
Certification is that they want to test themselves
regarding their knowledge base in a specific
specialty.

Likewise, a CAQ is very similar in that it is
testing a knowledge base to help grow an
individual educationally and professionally. Where
is the wrong in either of these? Additionally,
Board Certification does not guarantee granting of
hospital privileges nor does is protect the public
as witnessed by the fact that our residents and
fellows newly graduating from our residency and
fellowships (and other medical specialties) do not
have Board Certification in surgery (or medicine)
yet are credentialed to perform surgeries or
admit/treat patients at various facilities around
the country. We all know excellent board certified
Podiatrist but we also know many who are not! The
individual State Medical Boards help protect the
public not the ABFAS or the ABPM.

One final thought is that of fellowship training
within our profession. Currently, fellowship
training leads to no board certification but is
purely done as a furthering of one’s educational
experience both clinically and academically. A CAQ
and or board certification does the same---
physicians gravitate towards these to grow
educationally and again this is only a positive,
not a negative for any profession.

I do find it gratifying that we are voicing
opinions and dialogue is occurring. We need more
of this to continue to grow our podiatric
profession. However “board bashing” or name
calling is never positive but only brings on
attitudes that will continue to divide our small
profession. As one who is Board Certified by both
ABPM and ABFAS and have sit on committees for
both, I can see “both sides of the street”. That
being said, the Boards and CPME together need to
address this and all other issues and come to an
equitable arrangement. I have mentioned in the
past that If we had one Certifying Board this and
many other issues would never happen so now is the
time to evaluate how this can be attained to unify
and strengthen our profession.

Timothy Ford, DPM, Louisville, KY

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09/29/2022    Allen Jacobs, DPM

AACPM Statement on Board Certification (Lawrence Oloff, DPM)

The derisive commentary of Dr. Lee Rogers with
regard to the AACPM was the classic straw man
argument so often used by politicians rather than
academics. I find myself in agreement with Dr.
Oloff. The comment was insulting to our
profession.

Many of the old podiatrists such as Dr. Oloff,
have watched the incredible growth of this
profession and concurrently, the increasing
acceptance and incorporation of podiatry in
medicine. Young practitioners cannot possibly
imagine the time past when a podiatrist could not
prescribe medications, administer an injection,
perform surgery or provide services in a hospital.
There was such a time. Or be paid by third parties
for their services.

The current state of podiatry came to fruition by
the building of education, responsibility, and
accountability. We are now trusted to perform
significant surgical procedures, participate in
limb salvage and wound care with potentially
devastating consequences to trusting patients with
failure. We think nothing of prescribing or
administering any therapy or medication required
for management of pathology which we treat. We are
accepted by and receive referral of patients from
the health care community.

All of this was accomplished in no small manner by
demonstrating excellence in patient care and
treatment outcomes. We are trusted to determine
the school curricula and post graduate training
necessary to provide the public with safe and
effective care. We are also trusted to determine
the requirements for certification in the
provision of surgical services. There is a
responsibility which attends this to maintain
credibility and to assure the public that it may
remain confident in their care by a podiatrist.

In my opinion the profession must define those
surgical services which a non-ABFAS certified
podiatrist may provide. There are many non-ABFAS
certified people that I know who are very
surgically capable. Once agreed upon, a true
standard for ABPM CAQ should be established,
rather than a “come join us we are easy” standard.
ABFAS must participate in setting this standard.
Having established a delineation of accepted
privileges in surgery and a legitimate method to
assure the capability of those holding an ABPM
surgical CAQ, ABFAS and podiatrists in positions
credentialing applicants shall support such
applicants.

If we fail to do so, I fear our profession will
not be trusted to provide safe and effective care,
and our growth and autonomy will be threatened. We
have enough problems and challenges in today’s
health care system. Increasingly NPs, PAs, PCPs,
AAFAS, non DPM “would care specialists “, PTs,
have been encroaching upon services which we have
traditionally provided. There is an old song
“nobody does it better “. We must succeed by doing
just that. Providing a CAQ with minimal
requirements will not serve to do it better.

The accomplished members of the board of ABPM must
consider their ultimate responsibility to the
public and secondarily to our profession providing
ABPM members with a useless CAQ as it now stands
serves no one.

Allen Jacobs, DPM, St. Louis, MO

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09/28/2022    Lawrence Oloff, DPM

AACPM Statement on Board Certification (Lee Rogers,DPM)

Every leadership group in our profession has
weighed in on the CAQ in surgery proposal by ABPM,
and the response has been a resounding NO.
Nevertheless, Lee Rogers has continued to push
this agenda forward. One really has to begin to
question the intent of a proposal that is rejected
by the entire profession? Deft ears? Self-
aggrandizement?

Why do we need board certification. It has two
purposes:
- “Board certified doctors demonstrate their
desire to practice at the top of their profession
and deliver high-quality care to their patients.”
- It also shows the commitment our profession has
to protect the public.

Practicing at the top of your profession does not
mean creating a third path that is based on the
need accommodate those that can not pass the
rigors of the surgery board. Isn’t this third path
in essence lowering standards? ABPM proposes that
graduates of residencies within three years allows
a person to sit for an examination, and passing
that exam entitles one to getting a CAQ in
surgery, thereby demonstrating superior competency
in surgery. This is simply ridiculous. A resident
works under the supervision of a surgeon. You
would not label someone as competent to drive a
car after practicing with their parent in the car
with a learners permit and then passing a written
examination. They would have to take an actual
drivers test and demonstrate competency behind the
wheel on their own. Dr. Rogers is proposing that
we require less of a surgeon.

ABPM should support ABFAS as the surgery
certification board of the profession. ABFAS
should support ABPM as the means of obtaining
certification in everything that is not surgical.
It should be nothing more and nothing less.

I find this dialogue by Dr. Rogers to be very
disturbing. It creates another wedge in a small
profession. His recent snide response to AACPM
statement on this issue which in essence tells
AACPM to mind their own business and that they
should focus on the poor student recruitment, was
unprofessional.

I do not mean to throw all the responsibility for
this misdirection on Dr. Rogers. Where is the
wisdom and common sense of the ABPM board?L

Lawrence Oloff, DPM, Burlingame, CA