What Does The Future Hold For Podiatric Surgeons?

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A Closer Look At The ASPS

Formed in late 2008, the American Society of Podiatric Surgeons (ASPS) is the surgical voice for the APMA and supports the association’s Vision 2015 project, according to the society’s Web site.

   The ASPS has available membership categories of Fellow, Associate, Affiliate, Resident, Student and Emeritus, according to bylaws posted on its Web site. It is not a credentialing organization.

   “The principal purpose of ASPS is to facilitate education and research activities in the area of podiatric surgery,” notes the ASPS site. “These activities are viewed to reinforce and support licensing and certification processes.” The society also notes it will offer educational programs and work with the American Board of Podiatric Surgery (ABPS).

   Michael Graham, DPM, is a Fellow of both the American College of Foot and Ankle Surgeons (ACFAS) and the ASPS. He joined the ASPS because he thinks it is important to have an organization associated with the APMA.

   “Even though I might not always agree with the decisions of the leadership of the APMA, we need a representative body for our profession,” notes Dr. Graham. “The higher the membership, the better political pressure we can have as a united front.”

   Bret Ribotsky, DPM, is a Fellow of the ASPS and notes that he opposed the schism between APMA and ACFAS. Dr. Ribotsky says it is up to the ASPS to provide value for its membership. He feels the ASPS needs to do a better job of sharing its goals and providing information on what it has accomplished. Officials from the ASPS did not respond to requests for comment for this article.

   Research is a critical goal for the ASPS, according to Dr. Graham. He notes that podiatric schools and residency programs must address the fact that podiatrists are not as well versed in research and publishing as orthopedic surgeons.
Stephen Barrett, DPM, is a Fellow of the American College of Foot and Ankle Surgeons and a Fellow of the ASPS. He plans to continue his association with both groups.

   In his conversations with colleagues, Dr. Barrett has gathered that many do not know how the situation with the ACFAS and APMA had occurred and some remain confused. He believes both organizations will grow.

   In Dr. Barrett’s opinion, if the profession continues with a collective and not divided effort, there will be “very positive change and patient outcomes will continue to improve for many things, which were considered untreatable a couple of decades ago.”

Brian McCurdy, Senior Editor

   Dr. Richie believes the APMA and ASPS cannot properly represent the surgical arm of the profession without the involvement of the ACFAS, noting the college’s decades as the profession’s surgical organization. Furthermore, he notes the APMA has evolved to have an identity as a voice for primary foot care and the association did so knowing that “ACFAS was always going to be there as our surgical advocate.”

Clarifying The Relationship Among ACFAS, APMA And The ABPS

What about the ACFAS’s relationship with other podiatric organizations such as the American Board of Podiatric Surgery (ABPS)?

   Dr. Lee says the college’s relationship with ABPS remains the same and notes the two executive committees recently met in February. As he points out, the formation of the ABPS came from the ACFAS in the 1960s. Dr. Lee says the ABPS is now independent and accountable only to the Joint Committee on the Recognition of Specialty Boards. Therefore, he notes the ABPS is and should remain neutral on issues outside of the board’s own operations.

   “We always stand ready to support their efforts since ACFAS is the only surgical organization that requires ABPS status for membership,” asserts Dr. Lee, a Diplomate of the American Board of Podiatric Surgery.

   The American Society of Podiatric Surgeons requires its Fellows to be certified by the ABPS while the Associates must be board qualified by the ABPS, according to bylaws posted on the ASPS Web site. The society’s other membership categories do not require an ABPS affiliation.

How Will The Potential CPME Changes Affect Podiatric Residency Training?

In addition to the new surgical landscape formed by the establishment of the ASPS, proposed changes to the CPME 320 may affect the surgical requirements of residents. Changes include lengthening residency training requirements from two to three years. The committee was due to vote on the final changes in late April.

   Several months ago, the CPME proposed dropping the word “surgery” from PM&S terminology in the residency statements, according to Dr. Lee. He also notes that proposed changes also lowered the requirements for H&Ps during residencies. For the college’s part, he notes it recommended to CPME that the committee retain “surgery” and require a much higher number of H&Ps during residencies.

   Dr. Catanzariti agrees that the word surgery should be a part of PM&S terminology and like Dr. Lee, does not agree with the proposal to reduce H&Ps.

   “Anything you can do to maintain the numbers and the quality when you are looked at by the public or certifying organizations should remain,” says Dr. Catanzariti, the Director of the Residency Training Program within the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh.

   As Bret Ribotsky, DPM, argues, the number of procedures is not a barometer of accomplishment for residents. He says the evaluation should focus more on competency. He adds that if residents perform the procedure wrong a number of times, they will keep performing it wrong.

   “The ACFAS has a long track record of pushing for better and more surgical training, and the result has been a transformed profession over the past 30 years,” notes Dr. Lee.

Is There Too Much Emphasis On Surgery In Podiatric Education?

The CPME changes “need to be a conscious evaluation of who we are as a profession,” according to Dr. Ribotsky, a Past President of the American College of Foot and Ankle Orthopedics and Medicine. “Are we a surgical specialty or are we a biomechanical specialty? The last thing you want to do is lose the medical side.”

   Dr. Richie feels the proposed CPME 320 changes would place too much emphasis on surgical training at the expense of biomechanics and other areas of podiatric expertise.

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Anonymoussays: May 27, 2010 at 12:26 pm

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?

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legondownsays: June 18, 2010 at 4:39 pm

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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