03/20/2024    Richard M. Maleski, DPM, RPh

APMA Policy Proposition 2-24: One Board in Podiatric Medicine & Surgery

If there is only one Board for board certification
in our profession, and it is going to include both
surgery and medicine, then how can non-surgical
podiatrists get Board Certified? There are DPMs
who don't want to do surgery. There are DPMs who
simply do not have an aptitude for surgery. There
are DPMs who cannot do surgery due to physical
impairment. How could they possibly pass the
surgical portion of the new Board if they aren't
in the OR, or don't stay current with surgical
academic material, or just don't have adequate
experience to retain their skill?

I know colleagues who fit into all 3 of those
categories, and thankfully, there has been ABPM
certification available to them, which has allowed
them access to hospital non-surgical staff
privileges and inclusion into insurance panels. I
was Boarded by both ABPM and ABFAS, and I found
value in both Boards. Both exams were rigorous and
academically challenging, in fact, in my opinion,
the medicine exam was more difficult than the
surgical exam. However, just by the nature of
surgery, if someone is not actively involved with
doing surgery, I can't fathom how they would be
able to pass a surgical exam. And if the surgery
portion of the exam is so watered down so as to
permit non-surgeons passing the exam, what is it
worth? Do you think any credentialing committee
at a hospital or insurance company is going to
place any value in a surgical credential that non-
surgeons also take and pass?

I've had the good fortune of opening the OR to
podiatrists at 2 hospitals, and in each case, the
only MDs and DOs who could do surgery in the OR
were board certified by their respective SURGICAL
boards. Not by medical boards. We cannot ask for
preferential treatment. That would destroy
everything we've worked for the past 50 years.

I also was one of four DPMs who established our
residency program at the University of Pittsburgh
24 years ago. At that time, we were one of a very
few podiatry programs at a university based
academic medical center. We underwent very intense
scrutiny before we were allowed to establish the
program. The main focus of this scrutiny was the
validity of our credentials: did our podiatry
school curriculum stack up against a medical
school curriculum? Was our board certification
process rigorous enough to allow the university
and hospital administrations and medical staffs to
be comfortable enough with our level of training
and practice standards? I can guarantee you that
if our surgical board credential also included
non-surgical podiatrists we would never have been
given any consideration.

We are playing in the healthcare arena that has
been set up by the medical profession, and we have
to play by the same rules that they play by. They
differentiate between medical and surgical
specialties, and we must do the same. If we want
to have one Board only, we can only do that
without diminishing either portion of the
credential. I can't see how a podiatrist who
doesn't do surgery for whatever reason could
possibly pass a rigorous surgical exam process.
And this would only result in a number of
podiatrists who would be unable to get any board
certification. We don't want that.

Richard M. Maleski, DPM, RPh, Pittsburgh, PA

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03/15/2024    Steven Spinner, DPM

RE: APMA Policy Proposition 2-24: One Board in Podiatric Medicine & Surgery (Meghan M.. Arnold, DPM)

Driving through Georgia one day I got stopped for
doing 10 miles over the speed limit (Okay…it may
have been more) by a Georgia state trooper. When he
asked for my license and registration, I discreetly
open my wallet so that he could see I had a Broward
sheriff’s office badge and identification card.
Although my credentials at the time were legitimate
his comment to me was “you boys from Florida all
have those so put it away”.

It became a meaningless credential because the
impression was that every car from Florida that was
speeding could whip out a police credential and
hope to get out of a ticket. We are not a uniform
profession with uniform training. We are a diverse
profession made up of many talented people
practicing different aspects of podiatric medicine
and surgery. To confer board certification from one
board on everybody in our profession would render
that credential as meaningless as a sheriff’s badge
from Florida on a Georgia highway.

ABFAS is not the enemy. ABPM hierarchy continuously
insults the organizations integrity and
misrepresents their pass rate. We cannot as a
profession follow the course that they have put
forth. When I was president of ABPS, I argued for a
system that closely resembled the dental model.
There were dentists practicing multiple
specialties, and they were oral maxillo-facial
surgeons who did more extensive training in that
specialty. That model has passed the test of time.
A general dentist or orthodontist would not think
about doing a jaw reconstruction. But by conferring
uniform board certification on every graduating
podiatrist, the public is not protected. There will
be no distinction between those doctors who have
met the minimal 3 year residency requirement and
those that have obtained additional training,
knowledge, and experience in foot and ankle
surgery. And the bar for that attainment is the
ABFAS certification process…and that bar should
never be lowered.

This is not an “elitist” ideology and its intention
is not to keep any member of our profession out of
an operating room. I have served on hospital
credentialing committees for many years and
privileges were always awarded based on training
and case logs, not which board certified you. Our
profession is at a very dangerous crossroad. We
can follow a model which distinguishes multiple
different specialties within our profession and
their expertise or we can homogenize the
certification process and make it meaningless. I am
at the twilight of my career, but I truly have
concerns about the future of my profession. If the
people advocating for a single board are allowed to
succeed I have serious concerns for our young
doctors and our patients.

Steven Spinner, DPM