09/26/2023    Frank Louis Lepore, DPM, MBA

The Relationship Between APMA and CPME (Keith D. Cook, DPM, Sylvia Virbulis, DPM)

Dear Dr. Christina and Dr. Virbulis,

I am writing to you today as the President of the
American Board of Multiple Specialties in Podiatry
to discuss our future. Recently multiple meetings
concerning Boards have been held without
resolution. These meetings ranged from the CPME
and SBRC, multiple meetings behind closed doors of
leadership of which we were not invited, Board
Summits in 2015 and 2023, and hearings that we
have had on the subject of Boards. One of the
“recognized” Boards held a Town Hall on Board
Certification in 2023, which APMA did its very
best to thwart.

It is clear that the APMA, CPME, SBRC, ABFAS, and
other organizations are conspiring to keep the
status quo.

The membership has clearly voted and wants to see
a “One Unified Board” without tiered processes
like any other allopathic organization, with clear
and transparent testing processes.

This problem that we face has been created by you,
with the standardization of the Residency prior to
Board standardization. This now has created a huge
problem for practicing podiatrists who now are
left behind if they graduated prior to 2015,
losing the ability to become recognized for
credentialing and billing purposes or to become a
member of certain hospital medical staffs, losing
state licensure because of a push to change
verbiage in legislation of podiatric licensure and
financially impacting their bottom lines and
ability to make a living and pay back student
debt, practice debt, and or personal debt that
they have incurred.

This now has a cascading effect of creating both a
problem for Podiatry in matriculation at our
schools, loss of membership to APMA, and loss of
now scope of practice to our nonqualified
allopathic counterparts via APN’s, who do midnight
courses or 40-hour courses and think they can do
what we do after 7 years of training or more. If
we do not fix this problem which we face, then I
fear we are utterly lost as a profession.

You have washed your hands of the situation and
state that boards cannot come together and that it
is our problem as the Boards. Yet the leadership
does nothing or is unwilling to hear the way we
can get out of this problem, or you are simply
unwilling to make difficult decisions, or to exert
the effort required for this to occur because of
the pecuniary motives. Dr. Verbulis’ comments on
the CPME and SBRC meetings were tone deaf, and her
comments have had a disenfranchising effect on
many of the podiatric membership. However, without
the leadership taking the driver’s seat and
bringing all parties together to find a solution
on this matter, then I fear APMA will not survive
either.

However, as I have always done in the past, rather
than complain as the American Board of Multiple
Specialties in Podiatry President, I have tried to
keep the negative comments out of public eyes and
tried to work with the other Board Presidents
without resolution. Our Board even acquired
another podiatric certifying Board – a
sophisticate transaction but one that was
accomplished with the will to do so – to make it
easier for us all to come together, yet we cannot
because of your poor leadership and clear
favoritism to ABFAS and ABPM. Our acquisition
should have been an impetus to show you that it
could be done.

However, your arrogance and ignorance has cost you
members and will continue to do so. So again, I
have a proposition for a solution to a pathway for
a single unified Board. The Board of
Otolaryngology is a prime example of those who
underwent similar issues that we face at this time
in their past history.

The APMA cannot try to outwardly distinguish
itself from CPME with all evidence to the contrary
and try to feign a lack of influence over the APMA
House of Delegates. There is clear agenda-pushing
here. Whether you would like to admit it or not,
APMA does operate as a Trade Union even though you
try to give the impression that you do not, all
the while padding your pockets with arbitrarily
required dual membership dues from all podiatrists
who wish to be part of their state podiatric
associations.

In addition, APMA has publicly announced that it
does not know how to unify the Boards or that it
has no jurisdiction, yet your actions with the
APMA House of Delegates, CPME, and other entities
where you strong-arm the organization as Trade
Union would imply otherwise. You are simply
unwilling to do so because of insidious conflicts
of interest you have with various groups.

My recommendation is to come clean as an
organization, and do the following for the good of
all podiatrists:

1. Acknowledge wrongdoing on your part for past
mistakes.

2. Dissolve CPME, thus disbanding its recognition
of all Boards. Leave all Boards defunct and now
powerless and on a level playing field.

3. Create a new Council of Podiatric Medicine and
Surgery Education called CPMSE.

4. Create a new Podiatry approved Single Board:
The American Board of Podiatric Medicine and
Surgery.

5. Create Fellowships under the Single Board:
a. Trauma and Rearfoot Reconstruction under AO
Trauma
b. Limb Salvage
c. Vascular Podiatric Medicine to include
interventional stenting of arteries and venous
work.
d. Sports Medicine
e. Wound Care/HBO
f. Minimally Invasive Surgery

All these fellowships should be standardized and
regulated if promulgated by the profession.

6. Create a new Academy of Podiatric Medicine and
Surgery for the academic arm of the profession and
have subcategories as faculty, fellow, retired,
emeritus, etc.

Then, mandate that anyone holding any board
certificate from any of the three (3) current
Boards in Podiatry – (i) the American Board of
Multiple Specialties in Podiatry (having acquired
the American Board of Lower Extremity Surgery);
(ii) the American Board of Podiatric Medicine; and
(iii) the American Board of Foot and Ankle Surgery
-- will then be “grandfathered in” with the Single
Board with full rights and privileges. Also those
starting in 2025 must complete a 3-year residency
program, and they will have to take an examination
and submit cases as any other medical and surgical
board. Those types of cases can be determined by
the Single Board in the future as well as the type
of examination they would like to conduct but only
one exam. All exams results will be posted with
transparency.

The newly formed Academy of Podiatric Medicine and
Surgery will provide CME, which will be necessary
to maintain licensure and to maintain active Board
Certification status.

This will put all diplomates and all podiatrists
finally on a level playing field in the profession
and strengthen our membership and our cause as
one, clinically proficient profession.

The Single Board’s leadership would be comprised
of three members of each of the three (3) current
Boards, one retired podiatrist, and one lay member
and their chair would be rotated between each of
the Board members who were previous board
representative of the three (3) original boards
and later elected by the group and the membership
after 10 years.

The naysayers and opposition to this plan would
argue the following:

1. Training is not equivalent—It may be the case;
however, many were trained by others in the past
who never did a residency or preceptorship. A
great example of this is Dr. Yu from Yale.

2. This move would mislead and harm the public.
Well, if you have not already noticed, we do that
to ourselves with the lies and deceit in verbiage
used to describe what we do or the perceivable
qualifications or lack thereof of our peers.

3. Doctors who are not trained in procedures will
attempt them and create more harm. Physicians
should be credentialed at institutions based on
the training, qualifications, and/or case logs
that they present to institutions. They will be
weeded out through attrition and lawsuits with
poor outcomes that they will face and will pay the
price by losing the lawsuits and likely their
professional liability coverage.

4. Leave things the way they are. This is no
longer an option when this issue pervades our
profession and continues to hurt us.

Once this is completed then the esteemed members
of our profession will be better off. We can then
finally move on to bigger and better issues such
as:

1. One Single Board that is no longer confusing
and exclusive but rather inclusive leaving no
qualified podiatrist behind.

2. Seeking a national scope of practice, which
will allow us to rewrite and transform the laws in
each state and oppressive Medical Staff Bylaws at
hospitals throughout the country. Allowing doctors
to easily move across state lines and seek
employment.

3. Stop the encroachment of the allopathic
profession operating looking to take our turf.

4. Better compensation for all of us with parity
of payments and finally taking on the insurances
and CMS for better pay as unified body that
finally has its “stuff” together.

5. Looking to bigger picture of Podiatric
Globalization. Whereby we increase the fluidity of
our members in conjunction with other countries,
aligning the international podiatric counterpart
groups with our own to mimic ours and to allow us
to further their scopes of practice to be in line
with our own and creating employment opportunities
for our graduates and diplomates and strengthening
those relationships and bonds to make it better
for all of us and ultimately allowing for our
diplomats to transcend borders to practice.

I cannot stand all the lies, grandstanding and
fighting and change needs to occur and soon. I
implore all of you to look into the future and
stop the myopias of our profession and to begin to
open your eyes to a new vision of Podiatry where
we are one and united globally. If anyone has any
suggestions or comments, please reach out to me
personally instead of continuing to ignore my
outreaches or to block me or ABMSP from these
important conversations. But I trust that APMA
leadership will take note of my comments and begin
the process of rectifying the problem they created
with the solution I have given them, which they
seem to be unable to do or come up with on their
own.

Frank Louis Lepore, DPM, MBA, President American
Board of Multiple Specialties in Podiatry

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