06/13/2024 Allen Jacobs, DPM
APMA Policy 2-24. One Board Certification in Podiatry (Lee C. Rogers, DPM)
I had an interesting conversation with our chief of
orthopedics. We were discussing the two board issue
in podiatry. Non-podiatrists find this to be
confusing and find this sets us apart from the
remainder of medicine. He feels this leads to a
lack of credibility for our profession. He looks at
orthopedic surgery as an example. Regardless of the
residency completed, there is one orthopedic
surgery board. If you are an orthopedic surgeon or
certified or not, you cannot apply to our hospital
for spine privileges unless you demonstrate
adequate experience in spine surgery. We can go on
from there.
You have orthopedic surgeons who complete
fellowships and concentrate, for example in upper
extremity surgery, sports medicine, pediatrics,
oncology, and so forth. The point is, however, that
regardless of how narrow, the scope of practice an
orthopedic surgeon elects to practice, the
orthopedic surgeon still must satisfy the
requirements for one board. There are not separate
boards for feet, shoulders, knees, hips, infectious
disease, and so forth. The decision for privileging
is made at the local level based on competency and
experience. It is as simple as that.
Why then should podiatry be any different? By
virtue of having multiple boards, such as forefoot
versus ankle, medicine versus surgery, he points
out that the implicit implication is that not all
podiatrist are competent, and therefore great care
must be taken in evaluating individuals before
awarding podiatric privileges. If an orthopedic
surgeon elects to pursue orthopedic medicine and
practice non-operative orthopedics, they still must
pass the same board initially, and then elect to
limit their own practice. If an orthopedic surgeon
determines to limit their practice to arthroscopic
surgery they still must pass the same general
orthopedic board. I’ve yet to see presented any
cogent argument or doing otherwise in podiatry.
All podiatry residents complete a three year
experience now. Some doing an additional
fellowship. Obviously the experience is different
from residency to residency. Some residences
provide experience in complex, hind foot
procedures, total ankle replacement, trauma, and so
forth. Other programs do not provide the same
degree of experience. Realistically it is to some
extent no different in orthopedics.
There was probably a time as podiatry integrated
into general medical care in hospitals and medical
groups and joined orthopedic groups that scrutiny
was required and perhaps the need for two
certifications in surgery and perhaps a separate
certification in medicine might have been
appropriate. I do not believe this is the case any
longer. Ultimately, as our chief pointed out, this
is confusing to those in medicine, as it does not
conform with the manner in which general medicine
credentials individuals for privileging.
The most concerning aspect of this debate to me is
that we do not want to lower the standards to
obtain board certification. Whether you choose to
practice non-operative orthopedic medicine,
practice, general orthopedics, or practice
orthopedics with a limited scope of services
provided, you must still pass the same board. It is
rigorous.
Board certified or not, ultimately privileges are
determined at the local level. Orthopedic surgeons
treat the entire body and yet are able to maintain
a credible credentialing process with one board.
Podiatrists treat only the foot and ankle and have
a multitude of ridiculous boards. It does not look
good to the rest of medicine. There must be change.
Change will not come easily. There are economic
interests with individuals and organizations,
making quite a bit of money and gaining quite a bit
of egomaniacal and megalomaniacal satisfaction by
maintaining a plethora of useless boards. They will
of course fight this to the end. That is a reality.
This has got to end. As we all know, there are
minimal qualifications to get board-certified in
for example geriatrics or diabetic foot or limb
salvage. Really, what does that represent? Do you
think for one second if you present a non-rigorous
essentially phony board certification to me that I
will accept this and award you appropriate
privileges based on a silly board that had you sent
a couple of reports and a check? Of course not.
This profession has come too far not to change. We
have got to begin to assume the standards that are
utilized in medicine in general. I generally agree
with the board propositions that have been
advocated in PM magazine. However, I have concerns
about the manner which we are going about
addressing this. There has been an amalgamation of
silly boards. They cannot be accepted or included
in my opinion. This immediately discredits the
board certification process. People talk about
older podiatrist, having been grandfathered into
the boards. In fact, prior to the current surgical
boards, testing was performed to achieve a
fellowship .The test was a written and oral test
and was very legitimate. I took that test for two
days and then served for years on the examination
committee. In some respects, I think it was better
than the current board.
My thoughts?
1. Transition to one board only. The board should
be in podiatric medicine and surgery.
2. Disband immediately the plethora of ridiculous
boards now available. Orthopedic surgery has one
board for the care of the entire musculoskeletal
system. Podiatry has boards in geriatrics, limb
salvage, pediatrics, minimal incision surgery,
diabetic foot, and on and on. These boards
represent minimal if any academic/clinical
accomplishment. They are meaningless. All pseudo
boards must be discontinued.
3. End the foot vs. rearfoot- ankle- reconstructive
board. There should be one board. Orthopedics does
not maintain a spinal board, shoulder board, etc.
4. The singular board must be representative and
fair. This does not translate to easily obtained.
Eligibility should begin after a proscribed,
determined period of practice following residency.
5. Podiatry privileges should be awarded at the
local level based on an individuals knowledge that
experience and demonstrated ability. That is how it
is done in orthopedics.
6. Everyone must agree to recognize and accept only
the one accredited board as it is in orthopedic
surgery.
7. Acknowledge that we must update our standards
with and conform with medicine. Things have
changed. The old thought leaders in our profession
did no total ankles, did not likely have much
experience in ankle fractures or major hindfoot
fractures, or did much cavus or flatfoot surgery.
They learned and gained experience following
residency (if they even completed a residency)
those days are gone.
8. We must consider the future of our profession.
Are there some who might be left behind? Yes there
may be. However, if we are to maintain a credible
profession we must function in a manner analogous
to medicine. Reform may be temporarily painful, but
to do otherwise will continue to set us apart from
the standards accepted in medicine.
9. Complete your residency. Qualify for and pass
THE board. Obtain delineation of privileges at the
local level based on individual experience and
competency, not on board certification.
Allen Jacobs, DPM, St. Louis, MO
