News From ACFAS

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Applications are still being accepted for the ACFAS Board of Directors. The ACFAS Nominating Committee seeks experienced members to participate in the upcoming election to serve on the College’s Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to help lead the profession, submit your nomination application by September 15, 2021. Visit acfas.org/nominations for the nomination information and application, including complete details on the recommended criteria for election candidates. Note the application submission process will now be completed using an online application process. Don’t miss your chance to register and hear the inside scoop on fellowships! The College is hosting a complimentary webinar on Thursday, August 26 at 8pm CT (9pm ET; 7pm MT; 6pm PT) entitled “The Fellowship Experience - Is Advanced Training Right for You?

Are you thinking about your plans post-residency and curious about the fellowship experience? Attend this free webinar to hear advice from recent post grad fellows and current fellows and help to determine if a fellowship is the right choice for you.

This session will cover how to make an informed decision on fellowship; how to be a competitive applicant; how to choose the right program; how to maximize your fellowship experience; and the unexpected benefits of participating in a fellowship. Additionally, there will be time at the end for questions from the floor.

Find more details on the speakers and register at acfas.org. The ACFAS Fellowship Committee recently determined the following four fellowships exceed the minimal requirements to be upgraded to Recognized Status with the College after their first successful year:

Hinsdale Orthopaedic (IBJ) Foot and Ankle Fellowship
Joliet, Illinois
Program Director: Brian J. Burgess, DPM, FACFAS

Rocky Mountain Reconstructive Foot and Ankle Fellowship
Denver
Program Director: Alan Ng, DPM, FACFAS

Northern California Reconstruction Foot and Ankle Fellowship
Redding, California
Program Director: Jason Nowak, DPM, FACFAS

Virginia Fellowship in Reconstruction, Revision and Limb Preservation Surgery of the Foot and Ankle
Mechanicsville, Virginia
Program Director: Laurence G. Rubin, DPM, FACFAS

Also, the following four new fellowship applicants have been granted Conditional Status* with ACFAS:

Certified Foot and Ankle Reconstructive Surgical Fellowship
Delray Beach, Florida
Program Director: Ashley Bowles, DPM, FACFAS

Salt Lake Regional Foot and Ankle Reconstructive Limb Salvage Fellowship
Salt Lake City
Program Directors: Scott Clark, DPM, FACFAS and David Seegmiller, DPM, FACFAS

Virginia Mason Franciscan Health Foot and Ankle Sports Medicine Fellowship
Seattle
Program Director: Eric Heit, DPM, FACFAS

Midland Orthopedics Foot and Ankle Trauma and Reconstruction Fellowship
Chicago
Program Director: Jonathan Hook, DPM, FACFAS

*All new Conditional Status programs are considered for Recognized Status with ACFAS after they have received status and the first fellow completes the program.

ACFAS highly recommends taking on a specialized fellowship for the continuation of foot and ankle surgical education after residency. If you are considering a fellowship, visit acfas.org/FellowshipInitiative to review a complete listing of programs and minimal requirements.

Foot and Ankle Surgery

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A study was held to ascertain a correlation between hindfoot alignment and metatarsal rotation as determined by weightbearing computed tomography (WBCT). The researchers evaluated patients who underwent weightbearing plain radiography (WBPR) and WBCT between 2015 and 2018, totaling 196 feet. The average CMA was 6.0 ± 16.2 millimeters, while average Kim and Saltzman angles were 7.7 ± 12.9 degrees and 2.8 ± 13.1 degrees, respectively. The average Meary angle was 182.0 ± 11.9 degrees. A moderately strong association was noted between the CMA and the Saltzman and Kim angles. Hindfoot valgus was linked to first metatarsal (M1) pronation and hindfoot varus with M1 supination. Inverse relationships between the Meary angle and the Saltzman and Kim angles were detected as well.


A study was conducted to evaluate the results of oblique sliding metatarsal osteotomy fixated with a K-wire without cheilectomy for hallux rigidus. A total of 43 patients were enrolled. The average participant age was 56.2 years, and the mean follow-up period was three years. Mean pre- and post-operative dorsiflexion angles were 53 degrees to 66.5 degrees overall; grade one, 66.8 degrees to 79.1 degrees; grade two, 59.1 degrees to 68.6 degrees; grade three, 43.3 degrees to 61 degrees and grade four, 40.8 degrees to 53.3 degrees. Mean pre- and post-operative visual analog scale scores were 70.1 to 6.5 overall; grade one, 74.2 to 3.0; grade two, 66.4 to 7.6; grade three, 69.5 to 8.4 and grade four, 71.2 to 6.0. Finally, mean pre- and post-operative Japanese Society for Surgery of the Foot scale scores were 61.2 to 86.6 overall; grade one, 63.8 to 93.6; grade two, 68.3 to 85.9; grade three, 54.4 to 83.1 and grade four, 60.5 to 83.5. No statistically significant difference was observed the surgical effects among the four grades.


Researchers translated the Foot and Ankle Outcome Score (FAOS) into Indonesian through standardized procedures and examined 224 patients with unilateral chronic lateral ankle instability over one year. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure-of-eight, numeric pain rating scale (NPRS) and Short Form (SF)-36 were used to evaluate the construct validities. The five subscales signaled adequate internal consistency and interrater test-retest reliabilities, while subscales of the FAOS moderately converged with those selected measures with similar constructs apart from the correlation of pain with the NPRS. The principal component analysis' outcomes showed that the five-factor structure of the FAOS was suitable for the Indonesian data, although six items—four in the pain and two in the other symptoms subscales—imperfectly fit their original subscales. Guyatt's responsiveness index for the FAOS' subscales shifted in the SF-36's physical function over one month and ranged from 0.37 to 1.27.

Practice Management

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A lack of optimism among medical providers about the future of healthcare and their career trajectory likely means that competition for licensed professionals to fill vacant positions is about to ramp up. Healthcare employers should waste no time organizing a recruitment strategy and prioritize the incentivization of existing employees so that they are more likely to stay. The pandemic has compounded recruiting issues, making it much more difficult to find and hire qualified staff and giving candidates considerable sway over the terms of their employment. Among the tactics employers can use to narrow their search and quickly acquire the right talent to fill vacancies is hiring a qualified Recruitment Process Outsourcing partner. They also can offer a higher salary and other monetary incentives to attract qualified candidates and simplify the interview process to make it as fast as possible. Employers should also vet candidates rigorously before making an offer and follow up immediately with candidates once a decision has been reached.


A new poll shows that most Americans have high levels of trust in physicians, nurses and pharmacists. The poll, from the University of Chicago Harris School of Public Policy and the Associated Press-NORC Center for Public Affairs Research, found that at least seven in 10 Americans believe doctors, nurses and pharmacists will do the right thing for them and their families most or all of the time. The high levels of trust for these healthcare professionals included Democrats and Republicans; men and women; and white, Black and Hispanic Americans. "Public health officials should really look to doctors, nurses and pharmacists to be the megaphone to deliver the message of the importance of getting vaccinated," said Michelle Strollo, a senior vice president in NORC's Health Research Group. The survey, which was conducted in June, involved more than 1,000 adults using a sample drawn from NORC's probability-based AmeriSpeak Panel.


Supporting LGBTQ+ patients should be a year-round commitment for healthcare providers. A first step is to amend intake, health history and insurance forms to have inclusive options for sexuality and gender identities, pronouns and gender-neutral language for sexual and romantic partners. Providers can make it standard practice to use gender-neutral language with patients in the exam room or at the front desk and request their pronouns and implement inclusivity at the bedside. Meanwhile, the American Medical Association advises providing visual cues that the office is a welcoming space, like brochures and educational materials addressing LGBTQ health concerns, a publicly posted nondiscrimination statement and posters from LGBTQ or HIV/AIDS nonprofits. The practice team also should be kept up to date on the latest LGBTQ health research and LGBTQ patients' requirements. Providers can also extend cultural competency awareness to staff, set up gender neutral bathrooms and ensure identity-affirming administrative processes.

Health Policy and Reimbursement

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The White House reported that 2.5 million people have bought health insurance through the online marketplaces created by the Affordable Care Act after the Biden administration allowed more time to enroll amid COVID-19. Individuals and small businesses have until Aug. 15 to buy coverage via HealthCare.gov. The special enrollment period was extended in part to help those who had lost their employer-related health insurance coverage as the pandemic rattled the US economy. The American Rescue Plan, passed in March, also lowered the premiums people pay for plans obtained through the marketplace, and families on average have saved $40 per person per month under the law, according to the White House.


More than six months after President Biden's term in office began, he still has not nominated a permanent leader for the US Food and Drug Administration. Some Democratic senators are opposed to naming Acting Commissioner Janet Woodcock to the permanent role, but healthcare experts are urging the administration to fill the post immediately. The White House said it is delaying the process to ensure Biden can nominate someone with the right background for the role. He selected Woodcock, a longtime FDA regulator, to serve as the acting commissioner in January, but opponents point out she was serving at FDA when opioids analgesics were approved, which later contributed to the opioid epidemic.


The US Department of Health and Human Services (HHS) is requiring all of its front-facing healthcare employees to get vaccinated against COVID-19. The policy will apply to more than 25,000 officials under HHS’ umbrella, including staff at the Indian Health Services and National Institutes of Health who operate health and clinical research facilities or could come into contact with patients. The US Public Health Service Commissioned Corps will also be included under the mandate. “Our number one goal is the health and safety of the American public, including our federal workforce, and the vaccines are the best tool we have to protect people from COVID-19, prevent the spread of the Delta variant and save lives,” HHS Secretary Xavier Becerra said.

Medicine, Drugs and Devices

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The US Food and Drug Administration (FDA) says it will soon be in compliance with a court decision that may require the agency to transition certain products previously approved as drugs to be regulated as devices. FDA lost a court case in April in the US Court of Appeals for the District of Columbia Circuit when the agency contended it had authority to classify some barium sulfate contrast imaging agents as drugs even though they also met the definition of a device under the Federal Food, Drug and Cosmetic Act. FDA had asserted that the classification of barium sulfate contrast agents was "intended to be consistent with a previous court decision" and in order to regulate all contrast imaging agents under an authority in the Center for Drug Evaluation and Research. FDA says the federal government is not appealing the decision and that borderline products will adhere to the court decision. The agency requested stakeholders to provide feedback on what products currently categorized as a drug may need to be transitioned to being regulated as a device, in addition to possible statutory provisions for a regulatory pathway. FDA also indicated it may publish a list in the Federal Register with products it concludes should make the transition.


A total of 23 states enacted legislation from March 2016 to July 2018 to limit the duration of initial opioid prescriptions to a maximum of seven days. Of those states, 17 set the limit at seven days or less, two at five days or less and four at three days or less. However, the effect of these policies on opioid prescribing has not been sufficiently examined. Researchers used the Medicare Part D Prescriber Public Use File between 2013 and 2018 to conduct a before-and-after cohort study using a difference-in-differences model with state-level fixed effects. The goal was to evaluate the influence of laws limiting initial opioid prescriptions to a maximum of seven days across all episodes of care. The researchers found that the mean number of days of opioids prescribed per enrollee declined by 11.6 days in states exposed to duration limits, compared with a mean of 10.1 days in control states. State laws limiting duration had a noticeable reduction in days of opioids prescribed among surgeons and dentists (0.90-day decrease per prescription), pain specialists (0.45-day decrease) and other specialists (0.29-day decrease). In the Medicare population, the total number of days that opioids were prescribed per enrollee decreased from 2013 to 2018, with a slightly greater reduction in states with laws restricting initial opioid prescriptions to 7 days or less.


In response to rising drug costs and drug shortages, a rising number of hospital groups, nonprofits and startups are manufacturing their own medicines. Nearly one-half of hospitals nationwide have received some drugs from these efforts, most of which center on generics. EQRx, for example, is creating brand-name drugs for cancer and inflammatory disorders to sell at "radically lower prices." Another company, Civica Rx, was founded three years ago by a hospital consortium and currently supplies more than 50 generic injectable drugs to more than 1,400 hospital members. Meanwhile, Walmart is selling its own version of insulin in partnership with Novo Nordisk for less than one-half the name brand price.