President's Perspective January 2018

Laurence G. Rubin, DPM, FACFAS

"90% of the game is half mental."
—Yogi Berra

Laurence G. Rubin, DPM, FACFAS
ACFAS President

My favorite thing about this quote is that the numbers don’t add up, but the point is made. I see the same situation when it comes to board certification. The numbers don’t add up, but the point is made—not every DPM is a surgeon. We have an issue in our profession that keeps coming up, but we don’t want to address it—just because you graduated from a college of podiatric medicine does not mean you are a surgeon. This is true in other medical professions; not every graduate from a college of allopathic or osteopathic medicine will become what they desired as their first choice.

There are several reasons why the American Board of Foot and Ankle Surgery (ABFAS) pass rate has recently become an issue. ABFAS is no longer allowing doctors to be board qualified for more than seven years. Before the change, it was possible to extend your qualification status beyond seven years. Let’s be honest, would any of you, knowing what you know, want a surgeon, or any doctor, taking care of you who was practicing more than seven years and not board certified? Instead of delaying the inevitable, those doctors who cannot pass the ABFAS exam will be weeded out earlier. I think seven years is more than fair. In my main hospital, all professions must be board certified within five years to maintain their privileges.

We want to compare our pass rates with other professions, but that is really not comparable. There is overlap between other professions, but that does not mean that they sit for each other’s board exams. What would the pass rates look like if dentists took the oral surgery boards or physiatrists took the orthopaedic surgery boards? I doubt the rates would be anywhere near what they are now. I believe those doctors who cannot pass the foot and ankle surgical board exam should take the podiatric medical board exam. There is a reason these boards are available, and their pass rates are much higher. I don’t believe there should be “other” surgical boards that have higher pass rates.

ACFAS is the leader in educating foot and ankle surgeons. It is not ACFAS’ job to educate doctors on how to pass the board exam—that was supposed to be done at the school and residency levels. Our job is to educate surgeons who are out in practice, that is why ACFAS requires board certification to become a Fellow member of the College. We know our audience and educate that audience.

Lately, there have been several crises in our profession, and they seem to be about numbers. First, it was the number of unmatched students to surgical residencies, and now we are hearing about the pass rate for the ABFAS exam. We have resolved the residency crisis, so the next barrier to everyone graduating from a college of podiatric medicine and becoming a foot and ankle surgeon (especially a board-certified one) is the pass rate of the board exam. That is not how it is supposed to be—not everyone will be, nor wants to be, a surgeon. Some of you have written to me and told me that I am part of a select group of elitists wanting to make a small profession even smaller. What I want is to define my profession and to secure its reputation. If the filter for being a foot and ankle surgeon is not at the residency selection level or at the board certification level, than where will it be? The numbers don’t always add up, but the point is made.

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