06/26/2024    Philip Radovic, DPM

APMA Policy 2-24. One Board Certification in Podiatry

Reflecting on my four-decade-long journey in
podiatry, I am reminded of the persistent
misconception that we, as podiatrists, should
strive for 'parity' with MDs, as if we are somehow
inferior. This misguided notion often arises from
comparisons with our orthopedic colleagues and
their inherent positions of power, as recently
evidenced in The AMA’s pathetic comparison of
orthopedics with podiatry. This misinformation
often overlooks the unique aspects and strengths
of podiatry as its own distinct medical and
surgical specialty. Here are several points in
defense of specialized certifications within
podiatry under a single board while also
emphasizing the need for us to set our own
standards:

1.Unique Scope and Training: Podiatry focuses
exclusively on the foot and ankle, encompassing
both medical and surgical aspects. Specialized
certifications from a single board enhance
recognized expertise while allowing certification
for standardized competency. This is the opposite
of what general bone doctors do.

2. Premier Specialty for Foot and Ankle Care:
Podiatry should not seek to emulate others but
take pride in being the premier specialty for foot
and ankle medicine and surgery. We are the true
experts in this field, and our training and
certifications should reflect this expertise.

3. Specialized Certification Reflects Expertise:
These certifications ensure podiatrists excel in
their practice areas, supporting continuous
professional development and lifelong learning to
maintain high patient care standards.

4. Standardization Challenges: While three-year
residency programs are standardized, the
experiences and training opportunities vary
significantly between programs. Specialized
certifications ensure competency in areas not
extensively covered during residency through
rigorous board certification processes.

5.Credibility and Trust: Specialized
certifications from a single board enhance
credibility by ensuring podiatrists excel in their
practice areas. This commitment to high standards
sets podiatry apart as the authority in foot and
ankle health.

6.Local Privileging and Competency: While local
privileging based on competency and experience is
essential, having specialized certifications under
a single board provides a standardized benchmark
for evaluating a podiatrist's qualifications.

7. Economic and Practical Realities: Transitioning
to a single board without specialized
certifications would lower the bar to accommodate
the diverse range of training experiences, which
may dilute the quality and rigor of the
certification process. Transitioning to a single
board that hands out specialized certification
like candy, however, undermines the credibility of
our profession, as does the current state of
“alphabet boards” we now have. Maintaining
specialized certifications within podiatry’s
premier certifying body ensures high standards are
upheld across all areas of podiatric practice
while allowing broader access to credible Board
Certification.

Podiatry’s history of fractionalization with
multiple boards, in my opinion, is a consequence
of educational opportunity. I propose that APMA
consider a clear and measurable three-year plan
to:

1. Direct CPME to consistently and rigorously
uphold and verify residency program standards that
can lead to a gateway certification, including
mandating that each resident submit a publishable
manuscript annually to JAPMA or JFAS.
2. Align podiatry school admissions with the
availability of residency positions that meet
these standards.
3. Ensure podiatry schools adopt curricula
equivalent to those in medical schools.
Implementing these steps will cultivate an
equitable and unified setting for the future of
podiatry, drawing high-caliber students and paving
the way for real professional equality and parity
within our own profession.

As a unique medical and surgical specialty,
podiatry benefits from specialized certifications
that reflect the diverse nature of foot and ankle
care. These certifications can ensure high
standards and reinforce podiatrists' credibility
and expertise, particularly if they are under the
auspices of a single credible board. The objective
is to strengthen and unify the profession by
expanding access to single-board certification and
eliminating numerous quasi-boards that confuse the
public and the medical industry. It's time for
podiatrists to embrace their strengths and set
their own standards, free from comparisons to
other medical specialties.

Philip Radovic, DPM San Clemente, CA

Other messages in this thread:

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06/14/2024    Allen Jacobs, DPM

RE: APMA Policy 2-24. One Board Certification in Podiatry (Jon Purdy, DPM)

Personally, I would approach things somewhat
differently, Dr. Purdy. I think we should have one
board and one board only. We should be in podiatric
medicine and surgery. If a person has a particular
interest in some area, for example, wound care,
limb, salvage, sports medicine or whatever, then if
you really feel, compelled to do so offer a
"certificate of added qualification”.

I personally do not feel this is needed or would
benefit any individual practitioner in the long-
term, I think this is a far better solution than
continuing with a ridiculous number of board
certifications in podiatry. If I treat an athlete
with a Jones fracture, my treatment is going to be
identical for that patient whether I am “board-
certified in sports medicine” or have a
“certificate of added qualification in sports
medicine“. The slicing and dicing of the foot into
multiple boards is frankly ridiculous in my
opinion. If you have an interest in peripheral
nerve surgery, join an interest group in peripheral
nerve surgery and follow your interest and passion.

Failure to have some type of “certification and
peripheral nerve surgery” does that mean that an
individual should not be doing surgery for Morton
neuroma, tarsal tunnel, or, nerve, and entrapments
were neuropathy. Where do we end this? Board
certification in pronation limiting surgery? Board
certification in trauma? Board certification in
peripheral vascular disease of the foot?

There is a difference between having a special
interest in one particular aspect of foot and ankle
care and claiming to have ‘board certification’ in
that area. It is simply not required. Knowledge and
experience are what is required. That is the basis
on which any practitioner should be evaluated.
Offering a series of meaningless pseudo credentials
does not advance our profession, but in fact, makes
us look silly and disorganized as we are not in
step with the remainder of the medicine.

Allen Jacobs, DPM, St. Louis, MO

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06/14/2024    Rod Tomczak, DPM, MD, EdD

APMA Policy 2-24. One Board Certification in Podiatry (Allen Jacobs, DPM)

I agree with Dr. Jacobs and his views he shared
with us in the June 13th PM News. It was quite
serendipitous that I came to The Ohio State
University College of Medicine. On May 19, 1995,
one of the podiatry students who is now a faculty
member at the University of Alabama, Birmingham
called and asked me if I had seen the advertisement
for the faculty position at Ohio State. To be
honest, I hadn’t but upon inspection it looked
intriguing. I had a friend who was a pediatric
spine surgeon, Tom Kling, MD at the University of
Indiana, and I called to ask him if he knew the
chair of orthopedics at Ohio State. He said he knew
him quite well.

He said he would call him right then for me but
warned me that Shelly Simon, MD was a well-
respected foot and ankle surgeon in the orthopedic
community and warned me that it was, “Shelly’s way
or the highway,” but I would be fine. Not more
than 30 minutes later, Shelly called me and asked
if I could come the following Wednesday to be
interviewed on Thursday and Friday. He also asked
if I could get a CV to him ASAP, but not to worry
if it didn’t make it by Monday. I had six
interviews on Thursday and six more on Friday. It
was grueling. A secretary was assigned to get me on
time from one interview to the next. When I was
done with the 12 interviews I was taken back to
Shelly’s office. He told me I had the position if
I wanted it and said come back next week with my
wife to find a house.

He said he called every interviewer 15 minutes
after the scheduled interview was done to see if I
was acceptable. He asked me if I was wondering why
I had been offered the position so quickly. I said
that I was speculating and he told me that when Dr.
Kling called him, Kling offered one statement that
literally got me the job. He said, “Tomczak thinks
like an orthopedic surgeon.” By that time I had
been a podiatrist for 18 years and taught at Des
Moines for nine of them. To this day, I have no
idea what Kling meant or how Simon interpreted
that. I’m not sure what thinking like an
orthopedic surgeon entails. We have the same
anatomy, same surgical principles to go by, same
rules in the OR, same instruments and same
standards for patient care.

Perhaps this was the Johari blind spot, things
about myself I don’t recognize but others do.
Maybe it’s best described by the idea that I have
never seen myself in three dimensions while
everyone else does. Relating to podiatry, perhaps
it is the things Dr. Jacobs so eloquently describes
about the board certification processes and what
the one process should be. How can the ABMSP offer
three certifications in foot and ankle surgery
alone? Are we divided into forefoot, rearfoot and
then ankle surgeons or are we foot and ankle
surgeons, maybe just lower extremity?

We throw around a lot of reasons why we have so
many subspecialties that mean nothing and they
won’t change privileges. Some podiatrists remark
we have these levels of certification because we
are protecting the public from practitioners who
are not capable of performing more complicated
ankle surgeries. How many complicated ankle
surgeries makes one competent? How many ankle
fractures are exactly the same?

I think the reason for so many different
classification systems is that none really describe
all possible fractures. Maybe a part of thinking
like an orthopedic surgeon is not thinking with my
wallet but thinking about my competence and
confidence when seeing a patient. How may
orthopedic surgeons really want to operate on
pelvic fractures? Is there the possibility that
orthopedic surgeons see a complicated ankle
fracture and send it to a well-trained podiatrist
who has shown competence in reducing and fixating
these fractures and the podiatrist is better than
the orthopedic surgeon with such cases. The
orthopedic surgeon is not thinking with his or her
wallet but what is best for the patient and he or
she will not refer it to a podiatrist because the
podiatrist is board certified by some just sprung
up board.

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

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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

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06/12/2024    Richard M. Maleski. DPM, RPh

APMA Policy 2-24. One Board Certification in Podiatry (Lee Rogers,, DPM)

While I appreciate the points Dr. Rogers brings up,
I still contend that there is a strong possibility
that some podiatrists will have difficulty
attaining board certification status if the
surgical portion of the board remains the same as
it is now. I've had the honor and privilege of
being on the faculty of the University of
Pittsburgh residency program since its inception in
2001, and also on the precursor program in
Pittsburgh before that. I've helped train over 130
residents and at least twice that number of
students over the 30 plus years of my career. I've
been a Residency Evaluator for CPME and have
evaluated about a dozen programs. Not all of the
aspiring podiatrists that have rotated through our
program and that I observed in the on-site
evaluations over the years have shown the aptitude
or the interest in pursuing surgery.

Granted, this number is very low, but it exists,
nonetheless. And why is this pertinent to podiatry
versus medicine? In medicine, medical students have
4 years of medical school to determine if they are
going to gravitate to a medical specialty or a
surgical specialty. In podiatry school, there is no
choice. The only residency training is podiatric
medicine AND surgery, as pointed out by Dr. Rogers.
So, the ob-gyn and ophthalmology residency trained
MDs that Dr. Rogers referenced have already
demonstrated an ability and interest in pursuing
these surgical specialties. It is reasonable to
assume that their chances to get certified in those
specialties would be greatly enhanced because they
already have shown an affinity to surgery.

In the past few years, the American Board of Foot
and Ankle Surgery has been criticized because of a
relatively low pass rate. Could this issue be due
to those few DPMs who never really had a real deep
desire to be a surgeon? Or maybe there are more
than just a few DPMs who haven't had a 100%
commitment to surgery? And I believe that surgery
requires a complete 100% commitment.

Dr. Rogers intimated that my generation of
podiatrists aren't all "surgical podiatrists" like
the younger generation. If his contention is true,
then just take the surgical boards and don't look
back. Or, keep both boards, and take and pass both
boards as I did, because you never know what the
future holds.

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