Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

Board Certification Part 1: Mistakes

I am reporting to you today from not-so-sunny Chicago, where I am participating in this year's ABPS Board Certification process. My plan is to write a short series about board certification, with the intent to help those who have yet to certify. Think of me as your guinea pig. If my experiences can alleviate even a small amount of anxiety in you you, our members, then I'm successful. In upcoming issues, we'll discuss the logging and case submission process, examination itself, and the notification process (for good or ill). I will try to be as forthcoming as possible, especially if it turns out I failed the exam. As embarrassed as I will be if I do fail, I will also editorialize about that aspect of things.

My plan is to go in some semblance of order, so we can cover the various components of certification. I feel it necessary to add a disclaimer here. As I am currently undergoing the process and have no idea whether I will pass or fail, you'll have to take what I say under advisement. Receiving advice from someone who fails the exam – I pray that won't happen to me – may not be the best idea. On the other hand, if I pass the exam, then perhaps I'll have some authority to speak. As a result of my individual experience and possible bias, I will post an eTalk thread so we may begin a useful conversation with others' perspectives that will provide our community with stronger information.

So, let's get to it. I'd like to take this week's editorial to discuss some of my story regarding the board exam process. I feel my story is instructive for some of the mistakes a podiatric surgeon might make.

Tonight's Premier Lecture is
Safe Antiseptics-
The first step in wound care
Tom Serena, MD, FACS, FACHM, FAPWCA

My Board Exam Story

largest mistake waiting 7 years to board certify First off, a quick review of where I have been. After my 3 year residency in Michigan, I worked as an associate for 2 years in Lansing, Michigan, then left for a multispecialty practice in rural Central Oregon for 2.5 years, and then moved to my current gig at the Western University, College of Podiatric Medicine. I'm reviewing this history because it is instructive in how to avoid my largest mistake: waiting until year seven to board certify.

A significant part of the certification process is logging and submitting your surgical cases to the board

As you may know, once a resident graduates and passes the ABPS board qualification examination, he or she has seven years to become board certified. A significant part of the certification process is logging and submitting your surgical cases to the board. A committee reviews chosen cases in detail (12 for the foot certification and 8 for the rearfoot reconstruction and ankle certification). In the past, the ABPS would inform you of your passage, and then you would take the oral portion.

Well, my friends, the ABPS changes, as does the world around us. Currently, the ABPS does NOT inform candidates if they passed or failed until AFTER they've taken the entire examination. Why this change? I don't know. As such, I currently have no idea if the Board has accepted my cases and passed me. Ugh.

My Mistakes and How to Avoid Them

Now, the mistake that I made was in waiting so long to certify. If I should be so unlucky as to fail some part of the certification process, I will not have any further chances to re-take the examination unless I were to requalify. Please send out your goodwill vibes to the universe on my behalf. I need them!

The important question, then, is why did I wait so long? Here is where those smarter than me will listen and act differently for their own sanity. Instead of starting immediately to log and track my surgical cases via Podiatry Logging Service (PLS), I instead chose to procrastinate and attend to my life's other responsibilities. I thought, "There's plenty of time to certify. There's no rush." But as we all know, life has a way of passing quicker than we intended.

Additionally, changing practice locations (and states) three times set me back due to the obvious loss of surgical volume that occurs when starting a new practice. Between state licensing, hospital privileges, insurance panels, and building up a practice from scratch each time, one loses a significant amount of time and cases.

My single biggest mistake was not keeping track of all of the necessary surgical documents needed to document cases

Finally, my single biggest mistake was not keeping track of (and perhaps evening obtaining copies of) all of the necessary surgical documents (radiographs, patient lists, hospital paperwork, etc.) from those various practices. Specifically, for me, after leaving Michigan, I lost a lot of surgical cases, and it was prohibitively difficult to track down all of the material. While in Michigan, I was doing work out of 2 practices, 1 wound clinic, and 4 hospitals, and at times, some of my patients were seen at more than one location. It was just too difficult to track them down in later years.

Luckily for those certifying in the future, this last mistake will not be as impactful, because the ABPS now requires surgeons to log EVERY surgical case performed, rather than cherry-picking one's best. Sometimes removing the human element from the equation cleans things up.

Here are MY RECOMMENDATIONS for those in residency, those starting practice, or in practice for a short time.

Don't procrastinate. If you do, you might end up in the same position as me.
Start logging your cases immediately. Logging is not difficult, and it's much easier to do a little at a time over a couple of years, than all at once at the last minute.
Consider it a disadvantage to move locations before becoming certified. Each new location requires rebuilding your practice volume, which eats up time. It also makes it difficult to gather all of the pertinent documents when it's time to submit your cases.
Perform every surgical case as if you're being evaluated by your peers (you should be doing this anyway). Since cherry-picking is no longer allowed, you don't want to have a case rejected because of a poor job.
Be organized. Read the ABPS 220 and 420 documents to understand the process. Knowledge is power.
Don't wait until year 7 to certify. If you fail, then you might have to requalify – never a good prospect.
Keep copies of your surgical case paperwork (radiographs, op reports, hospital notes, office notes, anesthesia records, consult reports, and other imaging). Hunting this stuff down in a 6 week period after the ABPS informs you which cases they want to detail, is very challenging. Also, if you happened to leave a practice under poor circumstances, it is possible for you to lose access to them.
Take radiographs of your patients as if the case will be submitted to the ABPS. They require preop, intraop or immediate postop (within 72 hours), and at bony consolidation. I know it's not always possible (or necessary) to do so, but it's in your best interest.
Don't panic if you break one of their rules. If you can reasonably explain why you're missing a certain document or had a complication, then you will be in good shape.

Consider the Certification by ABPM…it's Easier

I have spent this time talking about the ABPS certification process, but it's also important to remember that there is another board, the American Board of Podiatric Medicine (ABPM), previously the ABPOPPM. Besides the name change, there are some other significant issues of which you should be aware. With the name change came an alteration in the test format: case submissions are no longer part of the exam. This test is now "written" (more likely computer-based), making it a less daunting process. Additionally, there is no oral component. As such, the ABPM exam allows the young physician to sit for certification earlier, taking the pressure out of the surgical certification. Consider the ABPM exam also.

Board certification is not a fun process, but it is in your best interest to be proactive. Learn from my mistakes, and the certification process will be that much less stressful. Good luck.