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CME Life Skills

Update on ABPM

Lee Rogers, DPM

Lee C Rogers, DPM gives an update as to what changes have happened with the board and a new marketing plan to explain to residents and students why to certify with the American Board of Podiatric Medicine. **** This lecture is not available for CME ****

  • Author
  • Lee Rogers, DPM

    Medical Director
    Amputation Prevention Centers of America
    White Plains, NY

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    Lee Rogers has disclosed that he is a consultant for and receives financial or material support from KCI

  • Lecture Transcript
  • Male Speaker: Hello, everybody. It’s good to be back. I was here on Thursday, gave a couple of talks on wound care. Now, I’m representing the American Board of Podiatric Medicine and give you an update on some of the changes that have happened with the board and our new marketing plan that we’re now implementing with residents and students on why certify with the ABPM. Couple of things, one is that the ABPM used to be the ABPOPPM, the American Board of Podiatric Orthopedics and Primary Podiatric Medicine. We decided to shorten the name to make it, one, just a lot easier and more cogent. It brings into line with where we think the profession is going. For a while, we’re having various residency programs that led to certification in either medicine or surgery. Even before that, some of you may remember even the PORs that led to certification only in ABPO and then the PPM residency which led to certification in Primary Podiatric Medicine. They combine those two boards together and kept both names and then called it ABPOPPM. Now, the new residency model is that it’s a PMNS 36, so Podiatric Medicine and Surgery on the same model over three years. We felt like we needed to update not only what we’re testing on but also our name to really represent what the new model for residency training for the profession. Certification is different from licensure in the fact that certification is an earned credential for podiatric physicians who've achieved this level of skill and ability based on completion of specific advanced training in clinical experience and examination. We oftentimes focus only on the examination because that’s the part that everybody is nervous about when they go sit for their exam. I’ll tell you how the new exams work and how we’ve revised the way that the exam works. So no longer is there an oral exam. Everything is done on computer. Takes the subjectivity out of it because even as objective as you think an oral exam could be, there is always some subjectivity for the oral examiner so we’ve removed that subjectivity to try to make the exam as fair as possible and make it completely computer-based. The two certification boards that are recognized by both APMA and CPME and also the federal government are ABPS, which is now changing their name to ABFAS, so the American Board of Podiatric Surgery and they’re changing their name to the American Board of Foot and Ankle Surgery. I think the name is already changed. And ABPM. I sit on the exam committee for ABPM and we’ve had a lot of talk about what exactly we’re trying to convey to not only to the profession, students, residents, but also to payers and hospitals, what the certification means to them. We realized that we’re DPMs, Doctors of Podiatric Medicine. We’re not DPSs, Doctors of Podiatric Surgery. We all do some surgery as part of our practice but majority of what you do is really not surgical. It’s a comprehensive type of practice that most of us do. Eighty percent of what the average podiatrist does are things that we test on for ABPM. Looking at our diplomats and this is a self-report from our diplomats. We have roughly 20% of the profession is certified by ABPM now and that’s growing actually. We have 900 people taking the in-training exam this year. These are all residents who are taking the in-training exam which then will lead to the certification exam. We’re seeing a big upswing because of the change I think in the residency model and how much easier it is to become board certified for residents who are seeing a big swing there. But these are self-reported from our diplomats. Forty percent of our diplomats have been a residency director at some point in their career, 50% had been a hospital department chairman and 42% had been or currently are state political officer. Eighty-three percent of our diplomats have reported that the certification has helped them achieve hospital privileges. As you know, hospitals require board certification. Some of them even put a time limit on it now.

    [05:01]

    When you’re coming out of residency, you have five years to obtain board certification, that’s standard among the MD community. Now, the difficulty with ABPS is that it can take u0p to seven years to become board certified by ABPS. If you go to your hospital administration or your credentialing staff and you say, “Well, I know that you allow only five years to remain on staff while your board qualified, but our profession allows you up to seven years to become board certified.” That argument doesn’t usually go over very well because that involves a big bylaws change. Our goal is to try to get people certified as quickly as possible. This follows other models too, internal medicine. You graduate from residency, you can sit for the boards right away, become board certified. There shouldn’t be any reason why you’d have to be delayed and be in practice for a long period of time before you become board certified. The other thing we did was we got rid of the case documentation for board certification. There’s no need to submit cases anymore in a mass variety of cases. We feel like if you’ve done comprehensive residency program and you can pass the certification exam, then there’s no need to submit cases to be board certified any longer. Seventy percent of our diplomats have said that the ABPM certification has helped them gain acceptance onto an insurance panel. This was a sample from a multispecialty, multi-practitioner office in the Midwest from 2009. They looked at what different types of things that they were doing in their office, where the income source was coming from and how profitable it was for their offices. They made about $400 an hour on providing wound care to patients. For sports medicine, about $400 an hour doing that. Podopediatrics around $250 an hour. All the way down, there is surgery. I’m not belittling surgery because I do a lot of surgery myself and it’s fun and it’s a necessary part of our practice. But by the time, you get the patient ready for surgery, you have to preop them. You spend the number of hours, how long it’s taking you to do the surgery and you have the postsurgical phase and in PACU, the time you spend doing that and then the postop visits that you’re not getting paid for. It actually doesn’t reimburse as well as. It’s not the most profitable part of the practice. That’s what I’m trying to say for this regardless of the fact that we all may like to do it and do it fairly frequently. ABPM certification can help people reach their goals and this is really where we tried to hit it home with residents that are making decisions about which board or whether or not to become board certified by both boards. It validates your expertise in the care that you actually practice most. If 80% of our practice are things that we test on then this validates for you. It’s a much faster way to certification. Most people are board certified within a year after graduating from their residency now and they don’t have to wait up to seven years like they might with ABPS. It has long-lasting career value. It enhances your marketability to be able to say that you’re a board certified podiatrist and be able to say that relatively quickly too after graduating from your residency. Based on that previous slide, it can give you a stable footing financially. As I said, there are only two boards that are recognized by the federal government, the CPME and APMA and we’re one of these. In certain hospitals that I’ve been, sometimes when you’re getting privileges, they require one board over another and so we’ve had to spend a lot of time doing education with hospitals and making sure that they realize that both these options for board certification to basically qualify podiatrist as an expert. Podiatric physicians can become APBM certified within one year after they complete their accredited residency program. As I said, that differs from the surgical model which takes up to seven years. If you’re trying to get an insurance panel or to get privileges out of surgery center or at hospital, it can mean a lot to you to have that earlier certification.

    [10:04]

    It enhances your marketability. It definitely increases your earning potential being board certified versus not board certified. If you look at the national average for podiatrist, according to the Bureau of Labor Statistics, the average podiatrists earns $134,000 a year. Fifty percent of our diplomats report making more than 225,000 a year and about 20% of our diplomats report making more than half million a year. When we were going through the name change, I see this happening in our profession where people are, and I disagree with it, but they’re moving away from the term podiatry. They think that there’s negative connotation with the word podiatry. I’ve always been of the opinion that if you don’t like what the term conveys, if you feel like you’re not on par with another specialist or an MD then just be a good example in your hospital of what a podiatrist is and help to elevate what the word means if you’re unhappy with it. When we see some of our organizations moving away from using the word podiatry, like moving to foot and ankle medicine or foot and ankle surgery, but it’s in our degree as a DPM. You’re never going to be able to run away from it completely. I think the best thing is to embrace it. We’re looking at the name change whether to call it the American Board of Podiatry which we ultimately decided based on our diplomats who we did a survey and the American Board of Podiatric Medicine which fits again inline with our degree, Doctors of Podiatric Medicine to be board certified by the American Board of Podiatric Medicine. We did have some jokes going back and forth about how the ABPOPPM, they love podiatry so much that they put the word twice in the same acronym. We have significantly shortened it which makes it a lot easier to put on your business cards and on your certificate and trying to explain your credentials to people. There is also some criticism with ABPO initially that it was attempting to use the term orthopedic. In the podiatric definition of orthopedic is more biomechanical but it was attempting to use the term orthopedic to confuse those in the public that we were orthopedic surgeons. We wanted to get away from that criticism and decided to move forward with the name change. There’s two tests now. There’s a board qualification test and a board certification test. They’re both computer-based. You can take them in a computer center around the country. The board qualification test is a multiple choice test, similar to any other qualification exam. The certification test is different. It replaces the oral exam. We’re just rolling this out for the first time next year and I just took it a couple of weeks ago to test the test to make sure that it works. So I went to a testing center. How it’s going to work is that you’re given eight cases and these cases are going to be on the computer. If you recall from previous times when you were board certified during your exam, either by ABPS or ABPM, you might go into a hotel room in Chicago at the Hilton and you’d sit with an examiner and they would hand you a piece of paper. That paper would have the case on it. Then you would say, “Well, I think in this case, I would like to order an MRI.” If that was the right pathway, then they would hand you an MRI. You’d read the MRI. What we’ve done is we’ve removed any of that subjectivity and instead you get the case on the computer. You can click the test that you want to order along the side in the computer. The computer presents you the tests. If you click you want an MRI, it will show you an MRI or an x-ray. Now, it will allow you to go down the wrong path actually. The subjectivity part is where, if you might have been in with an examiner, that examiner like you or they knew your residency director, and you said, “Oh, I’d like an MRI.” They would say, “Well, are you sure you might not want to see a bone scan?” This kind of removes that subjectivity as well. It truly tests your knowledge on whether or not you’re going down the right path. At the end of it, it doesn’t really ask for a diagnosis.

    [15:03]

    You’re trying to make a diagnosis but what’s more important is that you have an informed differential diagnosis and you may read a case a little bit differently without being able to examine the patient than I do. We think it’s important to have a good working differential diagnosis instead of taking an exam and making a single diagnosis. We have a list of maybe 50 diagnoses and we ask you to pick five that would be the top five diagnoses for the differential and you move those from one column to the next and then you click submit. We think that it will be much better being able to take it in your hometown as opposed to traveling Chicago. It’s going to save your money and time. We think that that will be an added benefit. It’s early, I’m happy to take any questions on the board or about the exam, except I won’t tell you what the questions are. Alright, well, thanks a lot.