President's Perspective January 2018
"90% of the game is half mental."
Laurence G. Rubin, DPM, FACFAS
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.
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.