01/12/2023    Paul Kesselman, DPM

Should board certification be required for licensure to perform ankle surgery? (Daniel Chaskin, DPM)

While I understand the need for board
certification, this question raises a problem for
many podiatrists who were not afforded the
opportunity to have a residency and learned under
the tutelage of others. Or those who had a one or
two year residency, which unlike the current model,
did not provide adequate training of surgical
reconstruction of the ankle. Again, these
individuals also took courses and studied with
other talented surgeons who taught these procedures
to them.

Currently, ABFAS does not afford an alternative
pathway to achieve certification in rearfoot/ankle
reconstructive surgery because of their
requirements unless one has had three- or four-year
residency with cases involving rear foot ankle
reconstructive surgery. Then of course there is the
written exam and orals.

Additionally, those of us who did receive training
by those formerly mentioned alternate non-formal
methods, have often taught the recent graduated
residents’ ankle and rearfoot reconstructive
surgery. While the residents can obtain
certification many of their instructors may be
unable to. Many of these ungrateful former
residents now in practice are now the very ones
calling for mandatory certification. The reason(s)
why are obvious!

Having had this discussion previously with many of
my colleagues, we also agree that the boards are
not the end all of training nor are they any
guarantee of skill. I and am sure many others
reading this have seen board certified surgeons in
all fields who they would not want operating on
themselves or a loved one, for even the simplest of
procedures. Visa versa, there are many gifted non-
certified surgeons whom we all trust if they or a
loved one required surgery.

Furthermore, a state scope of practice which offers
ankle and rearfoot reconstructive surgery to DPMs
does not automatically permit many of those
procedures to be performed in the sanctity of the
provider’s office away from public scrutiny. From a
practical perspective third party payers won’t
reimburse for those procedures unless performed in
a facility.

Facilities take this a step further and to minimize
their liability have a delineation of privileges
which often ask not only for certification but for
proof that one can perform the procedures
requested. This can be mismanaged by directors who
automatically disqualify qualified candidates due
to a lack of certification. That too is wrong!
Facilities often require that a surgeon already on
staff not only vouch for the credentials of those
applying, but they must be observed prior to being
granted unrestricted privileges, whether it be for
Matrixectomies or an ankle fusion/replacements.

Observation to ensure procedures are performed
properly and achieve the generally anticipated
outcomes are the absolute correct method by which
to measure of a surgeon’s ability. In other words,
prove you can perform the procedure to someone who
already has those privileges at the facility. This
protects the facility, the surgeon attempting to
gain those privileges and most important the
public. After all, isn’t public safety what this is
all about in the first place?

If one uses board certification alone to limit
one’s ability to work, I am sure a legal argument
could be made that this is tantamount to a restrict
of trade. After all, if one has the public
protected by other equally or more effective means,
then why are the boards needed for licensure?
Board certification for the practicing surgeon is
one which should be achieved and maintained. I am
in total agreement with that. However, board
certification must be reasonably achievable and not
be used as a tool by which to eliminate or restrict
the competition.

Board certification is only one method by which to
measure the skills of an individual, but it is far
from an end all. Ultimately all of us have a
Hippocratic Oath to abide by and failure to adhere
to those standards, no doubt will land one in a
land of well-deserved turmoil.

I vote no! The boards should have no place in
determining a state’s scope of practice.

Paul Kesselman, DPM, Oceanside, NY

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