06/09/2026    Rod Tomczak, DPM, MD, EdD

Maintenance of Certification (MOC) Through the National Board of Physicians and Surgeons (NBPAS)

MDs and DOs have another method for maintenance of
certification or recertification that caught my
attention. Someone sent me the article and
addresses for five additional articles that
explain the complete process through the National
Board pf Physicians and Surgeons (nbpas.org). In a
nutshell, this board requires initial
certification after completing an ACGME residency,
an active license and at least 50 hours of
continuing medical education over a two-year
period. This ACGME requirement would definitely
tell us why APMA and Patrick DeHeer, DPM have
tabled the offer by ACGME to visit some podiatry
residency programs. The only thing podiatry would
need to fulfil the stipulations set up by NBPAS
for recertification is the initial certification
of residency programs by ACGME. But remember,
NBPAS is a maintenance of certification program
for now, but things change.

One of the roads APMA and ABFAS uses to seek
parity is testing podiatrists to death. Test
results for first time RRA certification test
takers are not released by ABFAS but an estimated
mathematical formula for a pass rate is about 20%.
Somehow this correlates to RRA surgeons being
equal to orthopedic foot and ankle surgeons in
knowledge.

Let’s face it, outside of being granted hospital
privileges, board certification means little in
the real world. You just don’t see other
specialists one upping each other by signifying
their board status by signing the bottom of their
grocery list with their board status. NBPAS
emphasizes continuous learning rather than
obsessive testing. It’s like being a kid sitting
at the dinner table who isn’t allowed to eat until
he dazzles the rest of the family with the British
spelling of “orthopaedic.” Continued test taking
becomes a burden unless you have the residents
take the continuous assessment quizzes which,
incidentally, would make them completely invalid
and unreliable for future use. There is a German
idiom which fits the situation perfectly, Obgleich
es verboten ist, geschied es doch.

But when recertification does come along, it
becomes a real burden. Thoughts of failing part of
the exam are overwhelming. This leads to the three
hundred hours of preparation time you don’t have
like you did the first time around. Now you are on
active staff at the hospital and have mandatory
meetings of the library committee, cost over run
meetings because podiatry instruments cost so much
to perform certain procedures that threaten the
hospital budget, credentials committee meetings,
being on the board of the local cancer society,
that POD cast, scheduling a play date for your
kid, going to the field to applaud his T-ball hit
and the team award for 7th place runner-up,
missing dinner and study time because you got
called to the ED for an acute problem that could
wait another two weeks to be seen but it was a
convenient time for the patient, the local journal
club meetings, and oh, scheduling a date with your
wife and then your mother-in-law’s birthday
dinner.

Of course, there is the unnecessary burden on your
office staff for the maintenance of your
certification. I know a podiatrist who was too
busy to notice his trusted assistant was also busy
embezzling $10,000 while he was busy studying. You
can’t rob Peter to pay Paul. You can, but the cost
is what you pay plus 25% vig, maybe more.

Then there is the fact that practice interests
change over time. A neurosurgeon may evolve to
just performing spine surgery. I know a
neurosurgeon who only does cervical fusions and
Ob/Gyns who don’t deliver babies anymore. Why
should half the test be on labor and delivery or
brain tumors. I can’t imagine how a general
internist prepares for re-certification.

The NBPAS website says more than 250 hospitals
accept NBPAS certification for hospital
privileges. Not bad for an organization that’s not
that well publicized. The monopoly days are over.
What’s important for us to recognize is that
alternate boards are being accepted as equivalent
and hospital privileges granted. Podiatry schools
and residencies should have prepared us to be
life-long learners. Organizations like NBPAS only
give you the time to learn because you’re not
under the gun. Be honest, how many podiatrists
pass the recertification then don’t pick up
another text or journal for years?

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

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