07/04/2019    Alan Sherman, DPM

Call for National Debate on CPME 220 and 230 on a Single Board Certification within Podiatry (Jeffrey M. Robbins, DPM)

Jeff Robbins, DPM’s call for debate on the issue
of what constitutes a “specialty” board in CPME
220 and 230 (CRITERIA AND GUIDELINES FOR
RECOGNITION OF A SPECIALTY BOARD FOR PODIATRIC
MEDICAL PRACTICE) is interesting and part of the
broader discussion in the profession as to what
podiatrist actually are, in 2019, and what we
wish to work toward being in the years ahead.
It’s about our very identity, something that
we’ve struggled with as we’ve proudly built our
profession in the last 50 years into what it is
today.

Jeff’s interest as head of podiatry in the VA
system is, of course, an interest that we all
should share, as the VA policy is like Medicare
policy, in that it tends to trickle down to and
is often looked to as a model for policy in the
private sector.

The Council on Podiatric Medical Education(CPME)
is perhaps the most influential body in podiatry,
as it sets the standards for regulation of the
colleges, certification boards, continuing
education, residency programs and fellowships in
podiatry. In the years ahead, CPME will be called
upon to make substantial changes to their
policies to best regulate the way the podiatry
profession serves the foot care needs of
Americans.

The issue that Dr. Robbins raises is
evolutionary, not revolutionary – that the
foundation of podiatry practice is medicine,
biomechanics and office based procedures, and
everything else are sub-specialties. I have
raised this point in my writings on the future pf
podiatry, most pointedly in the blog, “Is
Podiatry a Surgical Specialty or is Surgery a
Sub-Specialty of Podiatry?” Jeff points out that
our current identity of all being advanced
surgical specialists is inconsistent with CPME
220 and 230, and has caused confusion in the
medical world outside of podiatry.

In fact, I think it has also caused confusion
within the podiatry world as well and has harmed
us. We are not all advanced foot and ankle
surgeons – nor should we be or do we want to be.
Most of what most of us do for our patients is
not advanced foot and ankle surgery. The American
public’s foot care needs are not mostly served by
advanced foot and ankle surgery. Advanced foot
and ankle surgery should be considered a
subspecialty of podiatry for which there is a
board certification. In fact, it is. The American
Board of Podiatric Surgery (ABFAS) does a great
job with that current certification.

The issue, then, is which board certification
represents not a sub-specialty of podiatry, but
podiatry practice itself, and I suggest that
would be the American Board of Podiatric Medicine
(ABPM) with some adjustments to language in their
documents and emphasis, to accommodate the
reality that the general practice of podiatry
does include some office based surgery. The issue
will then become where we draw that red line –
what procedures should be considered outside the
realm of advanced foot and ankle surgery and all
podiatrists, whether advanced surgeons or not,
should be competent in. But that’s an issue for
another letter.

Alan Sherman, DPM, Boca Raton, FL

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07/05/2019    Jon Purdy, DPM

Call for National Debate on CPME 220 and 230 on a Single Board Certification within Podiatry (Jeffrey M. Robbins, 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
practice.

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 certification."

Jon Purdy, DPM, New Iberia, LA