Podiatry Management Online


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08/12/2016    Jon Purdy, DPM


Board certification, in this day and age, is a
requirement to maintain insurance contracts and
hospital privileges in almost all cases. Unlike
days past, when certification was a badge of
honor and optional, today, not becoming board
certified can mean the end of a physician's

Like any political world, our profession is
intertwined among our state, the APMA and
multiple certification boards. To challenge
this, especially on a state society level, is a
political hot potato. Even individuals appear
to be fearful in using their names in posting
commentary. The APMA, through the HOD, in
conjunction with the CPME, gives the green
light to the boards of their choosing. It then
follows that states will transfer this decision
to their individual licensing boards, and
therefore the acceptance of hospitals and
insurance companies.

Knowing the severity of not becoming certified
should make one question the fairness and
oversight in the administration of such a
certification board. One should know that the
ABFAS (American Board of Foot and Ankle
Surgery) and the ABPO (American Board of
Podiatric Orthopedics) have "self-certified,"
and do not currently have any standardized
third party accreditation or other independent
oversight. This runs contrary to other well
know boards such as the American Board of
Orthopaedic Surgery, which have partnered with
the National Center for Quality Assurance
(NCQA) and National Quality Foundation (NQF).

Many may not be aware of the American Board of
Multiple Specialties in Podiatry (ABMSP). This
board is accredited by the American National
Standards Institute (ANSI) under the ISO
International Standards ANSI/ISO/IEC/17024:2003
for Accreditation for Bodies Operating
Certification of Persons, as well as accredited
by URAC (former Utilization Review
Accreditation Commission). Over the years, the
ABMSP has failed to gain acceptance by the
APMA-HOD, even using the same psychometrically
based testing and comparable certification
process as that of the ABFAS. The American
Board of Multiple Specialties in Podiatry has
certification tracks for wound care, diabetic
limb salvage, podiatric medicine, podiatric
orthopedics, and podiatric surgery.

The CPME and the HOD state that numerous boards
are confusing to the public and medical
communities and strive for unification. It
follows that one board certifying in multiple
areas would be preferred, according to this
stated mission. There is no board better
qualified nor situated to fulfill this role
than the ABMSP. Yet, they remain a non-entity
in our profession.

In comparison, the ABFAS rules leave
podiatrists terminally ineligible for board
certification if "too much" time has passed in
one's career, effectively ending that
individual's career. There is no such
limitation by the ABMSP. If one meets all
criteria to sit for board certification, I
can't for the life of me understand why a
podiatrist would be deemed ineligible secondary
to having "too much" experience.

There are a number of ABFAS "criteria" in
becoming eligible to sit for board
certification, that are far more restrictive
than that of even the American Board of
Orthopaedic Surgery. Although ABMSP does have
minimum case numbers needed within a specific
time frame, they do not require “case
diversity” and do not require “site specific”
minimum number of surgeries. This is also true
of the ABOS. These boards do not pose these
requirements, because case diversity and site
specific surgical requirements potentially
force surgeons to operate outside of what works
best in their hands. There is also the
potential that these requirements compel a
surgeon to perform surgeries that are not in
the best interest of their patient population
in order to meet certification requirements.

Currently a podiatrist must join multiple
boards, pay multiple fees, and strain their
practice with multiple burdensome application
processes. This brings to question the current
system and political mechanisms this profession
faces. Although the ABMSP is equipped to solve
all of these extremely important issues and
flaws, they can't seem to beat the system. And
to this end, many of our colleagues will soon
face the inability to continue a viable
practice in the absence of "board

Jon Purdy, DPM, New Iberia, LA

Other messages in this thread:

08/15/2016    Christopher Lotufo, DPM, ABFAS President


Please let me address some concerns about the
ABFAS fee structure.

ABFAS' fees address the costs of the development
of fifteen different ABFAS exams - in-training,
board qualification, board certification, re-
certification, and self-assessment exams, and the
case evaluation process. Each year, approximately
60 ABFAS board certified members volunteer more
than two weeks of their time to meet and review
the current exams' performance, develop new items
for future exams, and strategize new exam

These meetings typically take place in January and
September, with this year's September meeting
taking place in Seattle. The ABFAS board of
directors meets four times per year. Two of those
meetings are held in conjunction with the ACFAS
and APMA national conferences. One takes place
during the September exam committees meetings, and
the other during the Case Evaluation/Review which
takes place in April in Denver. The ABFAS
executive committee meets at the same locations.

In addition, for case evaluation, more than 90
ABFAS board certified members volunteer for three
days (four to five if you include travel time) to
review more than 2,000 procedures submitted for
those seeking board certification. During the time
all of the committees meet, the volunteers are not
seeing patients or performing surgery, which means
that they are giving up not only their time but
their income to make sure that ABFAS exams are of
the highest quality.

ABFAS has one committee that provides oversight to
all of the examinations. This is a small committee
comprised of past ABFAS presidents, the current
president, and the ABFAS contracted
psychometrician. It meets annually to review all
exam performance, set exam standards, and make
policy recommendations to the ABFAS board. All of
these members are also on individual exam
committees making their volunteer time commitments
more than three weeks.

The fees are also for the costs of the San
Francisco-based ABFAS office which includes
utilities; taxes; maintenance; office supplies and
equipment; staff salaries and benefits; staff and
volunteer support and fees to CPME, JCRSB, and the
RRC residency program evaluation process (CREC)
and PRR; the IT infrastructure responsible for the
CBPS and case review software in addition to the
membership database, to name a few items. The
fees for examinations cover the costs for running
exams through Pearson Vue; the independent,
contracted psychometrician who scores the exams;
and ABFAS' administration of the exam. In
recognition of the financial impact one pays for
taking ABFAS exams, ABFAS does not charge an
annual fee the first year for those who are newly
board qualified, certified, or those who
successfully took their re-certification or self-
assessment exam.

ABFAS has not increased its annual fees since 2006
nor its exam registration fees since 2013 and is
concentrating on implementing administrative
efficiencies so that it does not have to in the
future. It is an independent organization that
does not take industry sponsorship or funding. We
are extremely grateful and appreciative of the
time and commitment of our volunteers.

If you have any additional questions, please
contact Kathy Kreiter, Executive Director,

Christopher Lotufo, DPM, ABFAS President

08/11/2016    Name Withheld2


I strongly echo the thoughts outlined in the
previous postings regarding ABFAS fees/board
practices. I am a young practitioner as well
and have consistently found the board directors
and personnel go out of their way to remain
difficult and disenfranchise our profession
from within and from day-to-day realistic
working conditions. They are politicians who
enjoy ego stroking and accolades.

As a student, these characteristics were
evident early on, where I had been forced to
believe ABFAS/ABPS certification is the be-all
end-all, which simply isn’t true. Moreover, as
the board attempts to attain parity among
medical specialties, particularly orthopaedics,
the certification process is found to be
comical and overly critical as to cover up for
underlying incompetence and inadequacies,
something I personally have been told within my
work place.

On an educational level, how is a candidate for
board certification expected to learn from
their mistakes and incorrect answering if all
we get is a generalized score for one portion
of the testing…..this subjective system is
accurately assessing my competency? Every step
of our education and residency training is
based on studying, learning from mistakes,
practicing, improving your knowledge and skill-
set for improved patient-care in all realms of
podiatric care. It’s clear this board operates
under their own special set of regulations,
having convinced themselves of a higher

I have also requested my name to remain
anonymous, as this board is biased and
discriminatory. They should feel embarrassed
by their behavior over the years, but they do
not and will not, as each year brings a new
cycle of idealistic office holders waiting to
establish their mark……clearly the joke’s on me
and appears I’m not alone.

08/09/2016    Name Withheld1


It is about time someone spoke up and mentioned
the ridiculous antics of the "credential you
can trust." The simple fact is that we can
pretend to be part of the general medical
community all we want, but go to any major
hospital/medical system and you will find that
no one had heard of the ABFAS/ABPS and its
certification doesn't matter at all for
privileges. In fact they will mention the
hundreds of other boards we have diluting our
already fragile profession.

Residency places a false sense of identity to
our young practitioners as they go from a
pseudo sense of equality in the medical world
to a reality of isolation and discrimination.
Meanwhile, those in charge of the credentialing
continue to make this transition difficult for
the new podiatrist as they try to shield
themselves from the reality that they have
never experienced working in the current
conditions, been on call at a hospital, or even
done any of the procedures they set up to
require for certification.

I am sorry that I did not take an 8th
consecutive x-ray for my 5th digit arthroplasty
as I am trying to be conscious of cost and the
stringent quality measures being set forward in
today's medical systems. The old American
adages reigns true in our profession even more;
eat your young, divide and conquer, it's not
what you know but who know, get to the top and
make it hard for others to do so.

Meanwhile those of use young podiatrists who
have dedicated many years in residency and
fellowship mastering our craft will at the end
be shunned by it. Maybe the credentialers
should be required to show their surgical logs
and series of post-op x-rays as well. Maybe
it's about time the "credential you can trust"
spends the money wisely and shows the general
medical community why it should be trusted and
allow the Board certification to mean something
to those that truly deserve it.

Name Withheld 1

08/08/2016    Name Withheld


I am board qualified physician in foot and
reconstructive rearfoot/ankle surgery starting
my second year as an associate. I was surprised
today to see a short email kindly asking me to
send $205 to ABFAS for my annual fee. The
email, oddly, left out what exactly the money
would be used for. Although $205 may be nothing
for some of our older physicians, that amount
of money is still quite a lot of us youngsters
trying to make ends meet. I decided to

We already pay $2,000 for the qualification and
certification exams each, so I assumed that
money was not for testing, so perhaps the $205
dollars is for the privilege of being board
qualified? Well, that does not make sense
either because the bylaws of ABFAS clearly
state that we are forbidden from advertising
that we are "board qualified.” I called ABFAS
and talked to a very nice lady in the
accounting department who explained that money
was for administrative fees, testing fees, and
to keep our profile in good working order.

What the ABFAS does not tell you, however, is
that each year the executive committee takes
expensive trips to expensive locations. A few
years ago, Panama. After that, Ireland. Last
year? Nice, France. These trips are, in part,
funded by this annual fee. The American Board
of Internal Medicine, a much larger
organization, used to take executive committee
trips to similar places until the members
complained. Where was their meeting this past
year? Philadelphia, where the headquarters is

Younger members vying to get board certified
through the ABFAS are already feeling
disenfranchised thanks to the increased
restrictions, rules, and number of steps toward
certification. It does not help that the board
members disrespect our hard earned money by
wasting it on these superfluous trips. I urge
this readership to email the president-elect,
Matthew Williams, DPM, to recommend
alternate sites for their meetings.

I hear San Francisco is nice in July. Maybe
they should go there next year.

Name Withheld

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