What Does The Future Hold For Podiatric Surgeons?

Brian McCurdy, Senior Editor

The ACFAS/APMA split was one of the most controversial developments to affect podiatry in years. Accordingly, this author talks to various podiatrists about the aftermath of the controversy, the emergence of the American Society of Podiatric Surgeons and how the proposed CPME 320 changes might affect both surgical training and biomechanical knowledge.

   When the American Podiatric Medical Association (APMA) parted ways with the American College of Foot and Ankle Surgeons (ACFAS) in 2008, did it mark a turning point for the podiatric profession? After a decades-long partnership, the ACFAS is no longer the surgical affiliate of the APMA and DPMs are wrestling with the future of podiatric surgery in the form of a new surgical organization and possible changes in surgical residency requirements in the Council on Podiatric Medical Education (CPME) 320 document.

   Two years ago, the ACFAS removed the requirement that those renewing college membership must maintain their APMA membership although the ACFAS did leave in place the provision that podiatrists must still belong to the APMA when they join the college. Fifty-three percent of the ACFAS membership supported the board’s decision not to require renewing members to belong to the APMA.

   “The split between these organizations is the worst thing to happen to the profession in the past 30 years,” asserts Doug Richie Jr., DPM.

   When the ACFAS changed its policy on APMA membership, the APMA said the college was in violation of APMA bylaws. After ending its relationship with ACFAS as the APMA’s surgical affiliate, the association founded the American Society of Podiatric Surgeons (ASPS) as its new surgical affiliate.

   Has the establishment of the ASPS affected the ACFAS membership numbers? By the end of 2009, ACFAS membership was at 6,100, a slight increase from 2008, according to Michael Lee, DPM, the President of the American College of Foot and Ankle Surgeons. He notes it was a record membership total despite the economic downturn and decreased membership in other medical organizations. About 80 percent of college members are fellows and 15 percent are associates. More than 98 percent of members renewed their ACFAS membership for 2010, notes Dr. Lee, who says this is consistent with recent years. Dr. Lee says these numbers signify that the membership sees “tremendous value” in ACFAS programs and its Journal of Foot and Ankle Surgery.

   In the past two years, he notes “a very small number” of the college’s members did not renew their membership in a dispute over the majority vote on the college’s membership requirements. Dr. Lee suspects the APMA had the same situation, noting that “the sky has not fallen for either organization.”
Officials from the APMA declined comment for this article. However, the association’s Web site notes that its membership is “close to 12,000.”

Can The APMA And ACFAS Resolve Their Differences?

As Dr. Lee points out, both the ACFAS and APMA now have similar membership policies granting their respective members the right to choose their own professional affiliations as is the case in other organized branches of medicine. He emphasizes the April 2008 decision by the majority of ACFAS members was in favor of the “right to choose.” In addition, he notes the ACFAS has not only maintained the requirement for APMA membership for admission to the college but the ACFAS official policy is to urge its members to maintain their APMA membership throughout their career.

   Dr. Lee also notes a difference in the mission of the two organizations. He notes the primary mission of the ACFAS is education and research while the APMA’s primary mission is government relations.

   “These missions have and should continue to dovetail nicely,” he says.


Very interesting article.

I am one of the generations stuck in the middle of a choice between the ACFAS and the APSP. I was also somewhat abreast of the issues facing both the APMA and the ACFAS. I am aware that to be an APMA affiliate, your organization must require its members to be APMA members in good standings. My question is: Why would you not want to be part of the APMA? It has the legislative ear to help us advance our profession. That should be enough to want to be part of it I would think.

As far as residency training goes, I help train residents. Surgery is an integral part of what our profession is in this day and age and requires excellent training to be proficient at. I'm not sure what exactly it means to have "too much surgical" training. It is up to the attendings at each residency to help tie in conservative treatment, as well as the biomechanics behind the procedure they select. You can't do surgery without a firm understanding of the biomechanics behind what you are in my estimation. We are not robots, who see an IM of 12 degrees and decide to do a Chevron. You MUST be able to answer WHY?

To believe that there is an advantage of one certifying board over another in podiatry is at best wishful thinking and at its worst another divisive wedge that has continued to diminish the profession itself. A three year residency? What purpose does it serve if the emphasis is not to broaden the exposure to all facets of medicine akin to that of the DDS/DMD-MD oral surgeon?
Truly those individuals with advanced technical skill will enter a world of - what appears politically - lower paying opportunities and demeaning servitude to state scope of practice laws. Despite the efforts of the APMA there is still very little understanding in the general public of what a DPM is or does. For the most part - after several decades - podiatry is not advancing toward the goal of integration into mainstream medicine, it is moving laterally. Consider this, the 3 year graduate will be well equipped in the OR and his/her level of expectations will be met - in some locales - with a not-so-hardy reception. I understand the need for an APMA and the component societies, but; do not believe there will ever be enough funds for lobbyists capable of taking podiatry to the next level - integration into mainstream medicine.

3 year residency, extreme student loan debt and a lack of jobs for the few DPMs will not change very much in a profession with less than fifteen thousand practitioners of diverse backgrounds. My suggestion is to do what very few so-called leaders have failed to accomplish - integrate and advance a profession which has failed to progress much in thirty years.

Thirty years have passed and the consensus of the American public is that podiatrists cut toenails. That's it.

Why doesn't the APMA invest in media spots like the dentists or plastic surgeons?
Why? Maybe they are too busy patting themselves on the back and enjoying some golf outings and meals at the expense of the profession.

Until some REAL changes are made podiatry will be to mainstream medicine what professional wrestling is to the NFL.

I can't in good conscience be PROUD to be a podiatrist - Podiatry and the incongruity of the profession has done more harm to well intentioned young people aspiring to do well, as physicians (hell podiatry can't even decide if they want to be physicians or not) healers, and socially responsible adults.

Podiatry has failed podiatrists.

My advice to young people is that if they want to commit to an extra year or two, go to medical school and COMMIT all the way. The 3 year residency is superfluous in contemporary society.

For evidence in real-world parameters check with your life-insurance and disability carriers.
Actuaries know just how much of a risk podiatrists are to insure.
Better yet try to borrow money to start a podiatry practice.

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