Blog Readers Argue About Board Certification: Is It Fair Or Another Way To Discriminate?

When I think about subjects that cause controversy, my last blog topic, “Making Interprofessional Education a Priority to Improve Podiatric Parity,” (http://tinyurl.com/cuefzz5 ) would not be at the top of my list. However, for some readers, it met the qualifications for controversy and they started a verbal parry over what I had said.

I had called for a new accreditation requirement for the colleges of podiatric medicine, namely Interprofessional Education, a common requirement for medical, nursing, pharmacy and other healthcare related colleges. In this new educational forum between all members of the healthcare team, there is an opportunity to break down barriers between the allopathic/osteopathic worlds and our podiatric one.

I always write my blogs independently but this month, I thought I would include some comments by readers to this blog because each side brought up valid comments. The conversation started with some “fightin’ words.”

Doctor A wrote: “Can we complain about professional discrimination when our own boards divide the profession?”

Now there was some controversy and it did not take long to hook a response from Doctor B, a podiatry thought leader and a specialist in children’s podiatric pathology.

“Our colleagues run the boards. The boards aren't dividing us. We are dividing us. This isn't a criticism whatsoever. It's the reality we are dealing with right now.

“The bylaws of ACFAOM require ABPOPPM Qualification/Certification to apply for membership, much like the surgical counterpart with ACFAS requiring ABPS status.”

He explained that if you didn’t participate in qualifying residency programs, “then you are not eligible to sit for the ABPOPPM board examination. Simple as that.”

Dr. B is right in his concept if not in the semantics. A doctor applies for fellowship status after completing a qualifying residency program and passing the ABPOPPM qualifying and certifying exams. Membership is available to podiatric physicians who meet qualifying case requirements and pay a fee for that status. (Visit www.acfaom.org for more information.)

Is There Exclusion From Within The Podiatric Profession?

Doctor A asked a reasonable question from his perspective: “Why would ABPOPPM exclude any licensed podiatrist? Make the exam hard but do not make absurd rules. The states respect our education and experience more than our boards.”

“Why would a primary podiatric board not accept all podiatrists? How do they benefit from this?

“I think if they are unfair to podiatrists, the APMA and CPME should not endorse them ... I can practice podiatric medicine in any state but cannot ever be board certified in it. Thanks a lot, ABPOPPM!”

“How about a little basic fairness to fellow podiatrists before dreaming about parity with MDs?”

Dr. B challenged his correspondent to do some research: “I think that you should look into why these boards/colleges were initiated and how the various residencies came about.

“Every profession is in constant evolution. Things that were valid 20 years ago may not be so anymore for a variety of reasons.

“We already have a body that represents all podiatrists (whether they are members or not) in the APMA. Why exactly should the ABPOPPM represent all podiatrists? Or the ABPS? The reason is for standardization. What is today's standard vs. what it was 20 years ago?

However, when you feel that you have been unfairly shut out, it brings out responses like those from Dr. A.

“Why would a primary podiatric board not accept all podiatrists? How do they benefit from this?

“I think if they are unfair to podiatrists, APMA and CPME should not endorse them.”

What About Public Perception Of ‘Board-Certified’?

I’m sorry, Dr. A. I cannot agree with you on that last comment.

Why should the ABPOPPM accept all podiatrists? For that matter, would ABPS ever accept all podiatrists who had surgical experience or those who took a surgical residency or those who do not?

Of course not nor should they. That is not the meaning of a professional board. Becoming board certified is meant to represent something to the public.

I did a very unscientific poll and asked what “board certification” meant to people not affiliated with medicine. I received the following responses:

• An expert
• The best doctors
• Someone extremely well qualified
• Doctors “I can trust to do a good job”

In Conclusion

Those of us in the profession can always identify those people who received board certification — surgical or medical/orthopedic — but who can’t proficiently perform a hammertoe procedure or diagnose a case of necrobiosis lipodica if it came up and bit them.

Gratefully, those are the exceptions and we still have board certification as a way to set apart those who have gone above and beyond.

Are there excellent podiatric physicians and surgeons who do not have board certification? Of course.

Let this be a lesson to those young podiatric surgeons who think that medicine and orthopedic board certification is not what you want and are planning to “hold out” for surgical certification.

While you are able to do so, get ABPOPPM certified. Then when you can do so, become ABPS certified as well and be one of the truly elite — a double-boarded DPM. I have talked with more than a dozen podiatric physicians who planned to become ABPS-certified and were unable to do so as their “time ran out” on their cases and they would be required to re-sit for qualifying exams. If they had their ABPOPPM certification, they would not be excluded from insurance panels or lose hospital rights in most cases.

There are unique benefits to ABPOPPM certification that I will discuss further in my next blog.



Vladimir Gertsik DPMsays: January 3, 2012 at 1:04 pm

I would like to join ABPOPPM but am not eligible due to the fact that my CPME-approved RPR has not prepared me to practice podiatric medicine. I am looking for a PPMR or POR. Does anyone know of a place I can find them?

RPR,PPMR, POR are all dead. It is time to look back at what happened and re-evaluate ABPOPPM qualification requirements.

Perpetuating old absurdities does not benefit anyone.

Reply to this comment »
Kelvin A. Barry, DPMsays: January 4, 2012 at 3:13 pm

My question is: Why are there so many different boards in our field? What is the point?

Reply to this comment »
Vladimir Gertsik DPMsays: January 4, 2012 at 3:18 pm

Let's make it interesting. I challenge ABPOPPM to produce 5 PPMR-trained board certified diplomates under the age of 41 (my age) who are not involved in making up the test. I bet I can beat at least four out of five. If I win, ABPOPPM will consider the changes I have proposed, and if I lose, I give up the fight and never mention the issue again. Sounds fair?

Reply to this comment »
Dr. Ron Raducanusays: January 4, 2012 at 8:00 pm

Dr. Barry,

There are only two boards that are recognized by the APMA. Also, most insurance companies and hospitals and their systems only really require or recognize one board, the ABPS.

The question I proposed in one of my blogs some time ago was that very question. With the new residency model, we really only need one board. The American Board of Podiatric Medicine and Surgery perhaps? I've been championing this cause for almost ten years and have been waiting quietly to see how this new situation plays out. I was even involved in a dialogue with one of these bodies about how to initiate this change. To be continued ...

Reply to this comment »
Vladimir Gertsik DPMsays: January 5, 2012 at 12:15 pm

I think one board with several areas of certification is a good idea.

Reply to this comment »
Anonymoussays: January 5, 2012 at 4:08 pm

No. You are either certified or you are not. Plain and simple.

Reply to this comment »
Suhad Hadisays: January 6, 2012 at 12:38 am

Okay, let us say that the two recognized boards are ABPOPPM and ABPS. My question is whether it is acceptable for a certifying board to completely "close-out" a track leading to certification with that particular board, in essence punishing those for the period of time in which they trained. If a particular track, say an RPR residency program, was at one time acceptable for sitting for board qualification and subsequent certification, what is the justification in closing it out completely?

Yes, times have changed and I believe even better changes are ahead for the profession, but many have been "grandfathered" in by the boards, professional organizations etc. I believe if one completed an appropriate residency for his or her time, and can demonstrate an appropriate, acceptable case load for submission, then he or she should be able to sit for certification.

Reply to this comment »
Dr. Ron Raducanusays: January 6, 2012 at 9:41 am

To what end?

Most insurances and hospitals require ABPS certification eventually and the ones that don't are going that way as well. Is this so bad? If the answer is yes, what is the alternative?

Within the next 10 years, non-surgically trained podiatrists will be a thing of the past (assuming you were successful in attaining a residency). The other big issue is that some have to actually pass the boards in the first place. This is very much glossed over but you have to have the proficiency to actually pass the boards. Those that don't have some serious issues ahead of them, which none of us can really approach.

This is why other alternate boards were created, most of which aren't recognized by the APMA, insurance companies and hospitals.

Honestly, this is a can of worms discussion. It can go on endlessly. Maybe Podiatry Today should consider starting a community forum for us to discuss this elsewhere ad infinitum.

Reply to this comment »
Suhad Hadisays: January 7, 2012 at 12:21 am

You are correct in regard to what board(s) are recognized by insurances and hospitals. I do not know that it is a bad thing. I do believe closing out certification opportunities is a bad thing. You are correct that the individual has to actually pass the board examination anyway, based on his or her proficiency and training. Why can't that be the rate limiting factor? Why does a track have to be closed out completely?

I will say that I know an individual who did an RPR/PSR-12 and a sports medicine fellowship. The individual after 2 years in private practice opted to have a non-surgical practice. This person was declined ABPOPPM opportunity for certification because the "RPR" track was apparently closed out in 2006. Why would such a trained individual not be able to sit for qualification and, if successful at passing, then be able to go for certification?

Just my thoughts. I agree it is a can of worms discussion!

Reply to this comment »
Dr. Ron Raducanusays: January 7, 2012 at 2:53 pm

You could not sit for the ABPOPPM qualification exam with an RPR type program since the mid 90s, if ever. This was because that type of residency did not have the same curriculum as the POR or PPMR type residencies back in the day.

Graduates knew this in advance if they did their due diligence. If they didn't, whose fault is it? They knew that an RPR led to nothing but one year of experience. Once again, it was up to THEM to know what they were getting themselves into.

This was not a conscious decision on the part of the ABPOPPM. It was a decision that the residencies themselves made to not comply with the curriculum requirements of a POR or PPMR type of approved program.

Can of worms all over again!

Reply to this comment »
Vladimir Gertsik DPMsays: January 7, 2012 at 10:27 am

To state that only surgery is valid is extremely short-sighted.

Hello big surgeon. Your services are not needed that much and there are too many of you.
In an average practice, surgery is 10%. If a DPM decides to refer cases out instead of doing them, nobody loses.

Hello big surgeon, things happen. Old age, accidents, malpractice and a million other things can make surgical practice impossible.

Our profession is immature and lacks intellectual culture. We measure our success by the size of our screws, not by the size of our brain.

Enjoy your $200 Lapidus, big surgeon. Your joy will not last.

Reply to this comment »
Dr. Ron Raducanusays: January 7, 2012 at 1:29 pm

I never stated that only surgery is valid. However, being a Board Certified Surgeon (by the ABPS), is required these days to consider making a living due to hospital and insurance requirements. Even if you never touch a knife after acquiring certification.

You are correct that the average podiatrist's practice is 10-15% surgery, but please don't minimize the fact that these surgical procedures do indeed help our patients. Whether we get $200 or $2,000 for what we do, I find doing surgery a very rewarding part of my practice, especially since I feel that if done in the right circumstances, it does help my patients overcome their pain and disease process.

I don't measure my success by the size of the screws I put in, but by the satisfaction of my patients. I know MANY others who feel the same way and are very successful in practice.

You talk about immaturity in the profession. Your "Hello big surgeon" doesn't really reflect a very mature attitude or outlook I'm afraid. Part of the problem or part of the solution?

Reply to this comment »
Vladimir Gertsik DPMsays: January 7, 2012 at 6:57 pm

I am not against surgery and practice it myself. The problem is ABPS guys going around and telling HMOs and orthopods that only ABPS is valid.

You have to know who your real friends are. There will always be a place for conservative podiatry. Look at dentistry. They have multiple areas of certification and are doing well.

Reply to this comment »
Vladimir Gertsik DPMsays: January 8, 2012 at 1:42 pm

Doing surgery for nothing would be not a big problem in itself, but you can get sued whether you get paid or not. Would you be able to afford higher malpractice premiums?
In return for being in-network, you get paid next for nothing for surgery. Does it make any sense?

HMOs have found a good friend in ABPS. Your board-certified work costs them nothing.
Given that our profession is willing to work for anything, why would any HMO ever pay more?
It feels good to spend time in OR but if you do not get paid, your business will fail.
Make no mistake, they are in the business of making money.
It is time to stand up to these crooks.

Reply to this comment »
Ron Raducanu, DPMsays: January 9, 2012 at 1:00 pm

Now you are comparing apples to oranges. Are you concerned about how people are certified in our profession or how you are getting paid by insurers?

If you are doing surgery on indigent patients, and are getting ZERO compensation for your services, you cannot get sued by them. This is part of a "Good Samaritan" situation. I used to work at an indigent care clinic and no one would ever take any of these cases because we were not compensated for our work there by anyone.

If you mean "free" in that you are under an HMO capitated contract, then your ARE getting compensated under the global guidelines of the HMO contract YOU signed. I deal with this every day. You aren't doing it for "free". You are doing it under the stipulations of a contract you saw fit to negotiate into.

Please explain how the ABPS as an organization got involved with making the HMO situation what it is today. Talk to some of the legislators and the deep pockets that lobby for this kind of thing.

You do not speak for me. "...our profession is willing to work for anything..."? Hardly.

Reply to this comment »
Dr. Jay Vancesays: January 8, 2012 at 10:35 pm

We are definitely behind other practices and non-surgical procedures do not necessarily need certification.

Reply to this comment »
Vladimir Gertsik DPMsays: January 9, 2012 at 10:31 pm

You can get sued for a free case, at least here in New York. Does it vary from state to state?

My comment on in-network reimbursement is about the fact that the board certification does not lead to higher payments. In some European countries, achieving an equivalent of board certification leads to higher salary .

But you are correct, we have deviated from my very specific question about RPR residency.
Suhad Hadi, DPM, is correct. RPR was accepted for ABPOPPM qualification for a few years.
I do not think RPR, PPMR or POR were sufficiently distinct. We all went to the same clinic and saw the same patients.

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