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Meet New ABPM Executive Director, Dr. James Stavosky

James Stavosky, DPM

James Stavosky, DPM

“Enjoy what you do every day. Be quick to listen, and slow to talk and anger.” These are the words that Dr. James Stavosky, the new Executive Director of ABPM, lives by. He enjoys golfing, fly-fishing and playing tennis with his two sons and his wife (who he refers to as his best friend.) Another thing Dr. Stavosky enjoys? His career in podiatry.

In his 35 years of experience in podiatry, Dr. Stavosky has built an impressive career focusing on wound care. Besides running his own private practice in Daly City, California, he is also the Chief of Podiatric Surgery at Seton Medical Center, the Medical Director of Wound Care at Seton Medical Center, and a Professor of Podiatric Medicine at California School of Podiatric Medicine.

How he found podiatry and how his career took surprising turns

Dr. Stavosky didn’t always know he was destined for a thriving career in wound care. He was first introduced to podiatry during graduate school at The University of the Pacific, where he worked as a student trainer. His advisor at the time “introduced me to her podiatrist, and he set me up to meet and work with some very progressive DPM’s in the area.” From there, he set on a course to study sports medicine.

Later, as a doctorate student at the California School of Podiatric Medicine, Dr. Stavosky got even more involved in the profession. “I volunteered to work on Saturday free clinics every week, and I was a TA for classes,” he says. “Plus, I attended all CME education seminars put on by CSPM—I even volunteered to work AV at those seminars.”

During his residency, even though he initially set out to work in sports medicine, Dr. Stavosky discovered his true passion was elsewhere. “I also developed an interest in foot and ankle surgery, but then found my calling in wound care,” he says.

After completing his residency, Dr. Stavosky worked in academic medicine as a volunteer until he was hired full-time as a professor. He began his career in a full-time position at the Seton Medical Center, teaching four days and tending to private patients two half-days per week.

His career took a turn for the better when he was given the opportunity to take over the wound care department. “No one else wanted to do it, but it put me on the map nationally,” he says. So, from 1987-1998, he was the Department Chair and professor at the Seton Wound Care (Medical) Center.

In 1998 Dr. Stavosky was appointed Chief of Podiatric Medicine and Surgery and opened a full-time private practice.

Board Certification

 Dr. Stavosky was a founding member of ABPM (then ABPOPPM), in 1993. Sitting for this certification was highly important to him, “first for academics, and later for medicine and wound care.”

He is also certified with ABFAS, which he pursued because he “was teaching in the surgery department at CCPM, but in the process realized just how important podiatric medicine was.” He went on to become Chair of the podiatric medical department as a result.

Although the sequence of Dr. Stavosky’s board certifications began with ABFAS, he notes “I would now do it the other way around.”, and advises his students and residents as such.

Teaching the next generation

 In addition to helping patients through his work in wound care, Dr. Stavosky notes that he’s most proud of his experience teaching.

His advice to aspiring podiatrists: “Enjoy what you do, it’s the greatest job in the world. If you don’t want to spend time in a particular facet of podiatry, such as surgery, there’s a tremendous amount elsewhere that our specialty offers, like wound care or sports medicine.”

Along with his academic position he does his best to stay involved in the podiatric community. “I volunteer as faculty for residents and students for both ABPM and ABFAS and am, or have been, on each of their Board of Directors.” He’s also on the Board of Directors at the alumni associations of the California School of Podiatric Medicine and The University of the Pacific. Plus, he lectures on wound care around the country.

What he plans to bring to ABPM

 Dr. Stavosky doesn’t take his latest honor and challenge as the Executive Director of ABPM lightly. He looks forward to “taking our organization, ABPM, to yet another level in the future.  He plans to “guide the ABPM Board of Directors and continue to grow our membership,” along with “getting even more young practitioners involved at the committee and director levels.  With our significant increases in membership, especially over the past five years, we’ve experienced a demographic shift.  We’re getting younger.”

He has ambitious plans, but if Dr. Stavosky’s career proves anything, it is that he is capable of achieving some impressive goals.

Clinical Presentation Skills: Evaluation and Management

By: Nichol Salvo, DPM

When a patient presents in any medical setting for initial evaluation, it is easy to focus on your area of specialty. That being said, having “tunnel vision” may cause you as the clinician to falter. A concerted effort must be made to consider the patient’s co-morbidities that factor into the etiology of their current lower extremity condition. How will this play into the treatment plan?

Consider the following case and the importance of whole patient consideration:

A 68 year-old male presents to the emergency department complaining of increased pain in the right foot with new onset edema and malodor. The patient indicates that pain was his initial symptom which presented approximately three days prior. The patient has a past medical history significant for DM, CKD, stage 3 lung cancer currently treated with chemotherapy, and major depressive disorder. Upon triage, the patient is noted to be febrile at 100.4 degrees Fahrenheit with all other vitals normal. The right foot is noted to have an ulceration to the right sub first metatarsal head with surrounding boggy, necrotic desquamation, heavy with foul odor. The right foot is noted with palpable pulses. The patient denies any knowledge of ulceration to the foot. Labs were obtained by ED staff and the white blood cell count is noted to be 16.1. Radiographs obtained reveal subcutaneous emphysema localized to the plantar medial and plantar central midfoot.

It is clear that an emergent incision and drainage is required to save the extremity. It is easy to get lost in the emergent conversion and transfer from ED to OR. The patient will require consent and it is discussed with the patient that given the circumstances, conservative options are not an option. However, what are the other details that must be considered with the current plan? What other questions will you need to present to your attending?

The patient is diabetic.

  1. What is the hemoglobin A1c? The patient should be advised during the time of consent whether this will impact his outcome.
  2. What is his current serum glucose? Is it elevated and must you consider a concomitant ketoacidosis?
  3. Is the patient NPO? When did the patient last eat or drink and will anesthesia have to be modified?
  4. The patient is on chemotherapy to treat his lung cancer. What are the other pertinent lab values? What are his neutrophils, platelets, hemoglobin, hematocrit, etc.? Based on this review, does the patient necessitate a type and screen in anticipation of a transfusion?
  5. Given his CKD and need for antimicrobial therapy, what is his kidney function at this time? Does your planned antibiotic regimen require renal adjustment to accommodate creatinine clearance?
  6. The patient may potentially require some level of amputation in addition to the planned incision and drainage. Is the patient’s depression managed or should mental health services be consulted to assist the patient in processing and managing the magnitude of what he is facing?
  7. Given his diabetic and malignant state, what is his nutrition status? Have you considered how to optimize his long-term healing by consideration of albumin and pre-albumin?

Having thought of these questions and their answers will not only provide a complete presentation but , also render better patient care. Considering the whole patient when treating the lower extremity is a necessary and critical component of your evaluation and management. There are almost always other things to consider.

 

Explained: Pathology Specific Biomechanical Exam Templates

By: Dr. Stephen Geller, Director, ABPM

Have you ever given someone something you thought would help only to find them using it in a completely unexpected manner? This is exactly what happened when the American Board of Podiatric Medicine provided residency directors with a full-page comprehensive biomechanical examination form. This checkbox form contained hip-to-toe measurements, both non-weight bearing and weight bearing, and in gait. The unexpected outcome was that these forms separated biomechanical examinations from the physical examination performed for most complaints. In reviewing these forms at residency on-site evaluations, there were inadequacies that led to misinterpretations of the examination findings or lack of supporting documentation for the given diagnosis.

CPME 320: Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies, (the document governing residency programs) contains multiple MAVs, including biomechanical examinations. These biomechanical cases are defined as: “…direct participation of the resident in the diagnosis, evaluation, and treatment of diseases, disorders, and injuries of the foot, ankle, and their governing and related structures by biomechanical means. These experiences include, but are not limited to, performing comprehensive lower extremity biomechanical examinations and gait analyses, comprehending the processes related to these examinations, and understanding the techniques and interpretations of gait evaluations of neurologic and pathomechanical disorders.” At no point does this definition state that a biomechanical examination is from the hip to the toe.

Patient’s present with a specific complaint and not all pathology requires a hip-to-toe examination to be comprehensive relative to the causative factors. Residency training is to impart advanced knowledge so that when in practice, the graduated resident will be able to perform pertinent aspects of the biomechanical examination and identify all contributing factors. This information is used to minimize risk of complications in plan of care. First year residents will be less familiar with the presenting pathology and require more guidance through a more thorough exam to identify those causative factors. A senior resident may require less guidance and identifies all causative factors much faster.

With the development of electronic medical records (EMR), the use of forms that are separate from the electronic documents is increasingly difficult. To bring the biomechanical examination into the physical examination where it belongs, EMR templates for pathology specific biomechanical examinations have been created. These templates consist of: Pes Planus; Pes Cavus; Hallux Valgus; Hammertoe, Lesser Metatarsal and Intermetatarsal Pain; and Proximal Examination. The templates are modular being combined to comprehensively evaluate the pathomechanics of a specific patient. For example, a patient complaining of neuroma symptoms with a low arch would begin with the Pes Planus template and where indicated insert the template for Hammertoe, Lesser Metatarsal, and Intermetatarsal Pain. If at the completion of this examination the findings do not fully explain the pathomechanics of the foot, then the Proximal Examination template is added.

 

Meet ABPM Director, Stephen Geller, DPM

Stephen Geller, DPM

Stephen Geller, DPM

Dr. Geller has been a Diplomate of the ABPM since 1997, and a board director since 2015.  He currently serves on the ABPM Examination Committee as sub-section Chair for the Qualification examination, and has been a committee member since 2008.  In fact, the ABPM App originated from the qualification examination committee under Dr. Geller, when a style guide and item writing manual were created for consistency in our examination processes. Dr Geller’s hard work with ABPM is also highlighted in the new pathology specific biomechanical exam templates now available through ABPM.

I am proud of the accomplishments ABPM has made in a short time. The importance of medicine in daily practice cannot be emphasized enough. In my opinion, Podiatrists need to be the best physicians in the hospital. I think it’s part of our training to listen carefully and examine thoroughly, putting us in a position to make diagnoses before other physicians get to see the patient. “

Dr. Geller has also served as an ABPM representative to the Council on Podiatric Medical Education (CPME) Residency Review Committee (RRC) for two terms, remaining as an at-large member of the RRC. He is an ABPM representative to the Collaborative Residency Evaluator Committee (CREC) and is a residency program evaluator for the ABPM, ABFAS, and CPME.  Dr. Geller holds clinical appointments at many of the colleges of podiatric medicine and is a past president of the Arizona Podiatric Medical Association.  Dr. Geller earned his Master’s Degree in Medical Education and completed a 13-year tenure as the founding Director of Podiatric Medication Education at Maricopa Medical Center in Phoenix, AZ.  His clinical practice has been recognized in Phoenix Magazine’s “Top Docs”, as well as one of “America’s Top Podiatrists” by the American Research Council.

Clinical Presentation Skills: History of Present Illness

By: Stephen Geller, DPM

Have you ever stepped in a hole and twisted your ankle? Well I recently had a 27-year-old female who was otherwise healthy accept for right ankle pain 3-weeks after a similar inversion injury. No other part of her foot or leg hurts. Her pain is sharp, graded 6/10, localized to the anterolateral ankle without radiation. Standing and walking aggravates the pain and there is still residual swelling and bruising in the area. Improvement has been noted with ice, rest, and ace wrap. She has no prior history of ankle injuries.

Presenting a case is no different than telling a story. Granted, storytelling is an artform itself, but if you can become a good story teller, your attendings will remember you and your medical records will stand out from the rest. In medicine it has become acceptable to use poor grammar, run-on sentences, and be plain old boring. It doesn’t have to be that way. I bring up documentation here because your presentation should reflect your note.

‘A 27-year-old female presents for right ankle pain. The patient states that she stepped in a hole 3-weeks-ago suffering inversion injury. The patient states that her pain is sharp. The patient grades her pain as 6/10. The patient states that her pain is localized to the anterolateral ankle. The patient states that walking and standing aggravate her pain. The patient notes that swelling and bruising remain. The patient denies prior ankle injuries or pain in other areas of her foot or leg. The patient has attempted self-treatment using ice, rest, compression in ace wrap without relief.’

Compare the two presentations. Which one do you think would catch your attention and keep you attentive for the rest of the complaint?

Story telling begins with a hook. You need something to grab your attending’s attention so that they will remain attentive throughout the rest of your presentation. One sentence that conveys the story that is to follow.

“Excuse me Dr. Jones, but my patient has a severely infected diabetic foot ulcer that will need admitting”. Ok, that one is easy. Everyone is going to pay attention as soon as you say severely infected and need admitting. Still you have cleared a path to tell the rest of the medical history.

“Mr. Smith returns for a noninfected venous leg ulcer fifty percent improved from last week”. Here is a rather mundane medical issue. The patient is doing fine and just returning for follow up care. It’s the 50% improvement that will grab the listener’s attention, so you can go on with the rather routine presentation.

Once you have your audience hooked, you must tell the story. If it were a real story you would want to demonstrate a personal tie to the problem or evoke an emotional response. Let’s face it, in medicine that is frowned upon. What your audience is listening for in medicine is the information needed to make the diagnosis. This is where you will demonstrate your medical knowledge. Regardless of which pneumonic you prefer, NLDOCAT or OPQRST, you can still make it more interesting. Success at this level will require a thorough understanding of the differential diagnosis, end-organ effects of systemic illnesses, and complications of prior treatments.

‘You know how you say that heel pain isn’t always plantar fasciitis? Well Ms. Johnson is here for left heel pain, but it’s not typical. One-week ago she began a new exercise program and developed 8/10 sharp shooting pain in the plantar left heel. No known injury is reported. This pain radiates posterior to the medial malleolus, up her calf, thigh and to the hip. She doesn’t have to be active to experience pain and there is no relation to time of day or shoe gear. Ms. Johnson has a history of low back pain but has never been worked up for this complaint. No history of joint swelling or stiffness anywhere in her body is reported. Since the heel pain began there has been no progression and slight improvement treating with ice, stretching, ibuprofen, and cessation of exercise.’

Heel pain is one of the most common complaints we see. The differential includes plantar fasciitis, nerve entrapment in the foot, tarsal tunnel, radiculopathy, systemic arthropathy, stress fracture, etc. The above history takes the listener through the differential diagnosis as told by somewhat of a story. There is enough information to have a pretty good idea of what you will find in the exam.

This is presentation of a history of present illness. If you become good at telling the patient’s story everything will flow. Apply this practice to your notes as well. Obviously, there is less leeway for a casual introduction to hook the reader but convey the information in full sentences. Try to start each sentence with a new subject such as pain, onset, treatment. It is not acceptable to begin each sentence with “the patient states…” This is the history, so it is assumed that anything in quotations is exactly what the patient states.

 

PASSED! VA Provider Equity Act (HR-1058)

The ABPM congratulates the APMA, Ben Wallner, Director of Legislative Activities and congressman Brad Wenstrup, DPM for their indefatigable efforts toward passage of the VA Provider Equity Act, which passed in the senate at 4pm EST today (May 23, 2018).  The bill will be on President Trump’s desk tomorrow for signature.  The significance of this legislation cannot be overstated.  While it’s immediate affect is contained within the Veterans Health Administration, the ripple effect on the profession of podiatry with respect to parity will reach far and wide.

“This bill reflects significant advancement in the education, training, and licensure requirements for podiatric physicians over the past 40 years,” said ABPM Immediate Past President, Dr. Steve Goldman. “Podiatrists deserve parity within the VHA, and our patients deserve the proven benefits of the best-trained experts in lower extremity care as part of their health care team.”. Dr. Goldman was one of several physicians asked to speak on behalf of podiatrists. Others included: Jeffrey Robbins, DPM, Director of the Veterans Health Administration Headquarters Podiatry Services and Chief of the Podiatry Section at the Louis Stokes Cleveland VA Medical Center, and Seth Rubenstein, DPM, APMA treasurer.

Click here to watch Dr. Steve Goldman testify before the VA House Subcommittee on Health Committee on Veterans’ Affairs. Read his full testimony here.

 

Fellowship Overview with Timothy Ford, DPM

Timothy Ford, DPM

Timothy Ford, DPM

Reconstructive Foot and Diabetic Limb Salvage/Preservation Fellowship

Sponsoring Institutions: KentuckyOne Health Jewish Hospital and University of Louisville

 In continuing our series about CPME-approved residencies and fellowships, this month we are featuring a one-year reconstructive foot and diabetic limb salvage/preservation fellowship at KentuckyOne Health and the University of Louisville.  Below are insights about the program from Director, Timothy Ford, DPM.

 

ABPM: What are some key aspects of this fellowship?

Dr. Ford: This program is a mix of surgery and medicine – it offers the best of both worlds. Unlike being on one service, podiatry, our fellows are on a variety of services throughout their 12 months. These rotations include plastic surgery, ortho trauma, infectious disease, foot & ankle clinic and our fellows also take ER call at University of Louisville.

This fellowship offers a wide range of experiences, but it can also be customized. If our fellow is interested in a particular area, we work with them to ensure they get a little more time on that rotation. For instance, if a fellow is really interested in traumatology, we’ll give them a few more months on that service, and make sure the attending in that area is working closely with them.

Of course, there are certain requirements that must be met for a CPME approved fellowship. So, all our fellows have to complete ortho trauma, and plastic surgery rotations. In addition, they must take a micro vascular course and cover foot clinic. Otherwise, there is room to mold the experience.

ABPM: What sets this fellowship apart?

Dr. Ford: We think of our fellows as junior attendings. They are given a lot of autonomy, although there is always an attending nearby. This program is especially great for those who get out of residency and don’t feel that they have quite enough experience, or just want to learn a little more. Our fellows leave with at least a couple hundred procedures. This program forces fellows to grow a little more and gives them an opportunity to do things on their own. But at the same time, attendings are always there and available.

Also, because our fellows work with fellows in different medical subspecialties, there is an increased awareness of podiatry, and it builds a better understanding and respect for our medical specialty.

ABPM: What are the research requirements for this fellowship?

Dr. Ford: Research is encouraged, and there are a lot of research opportunities through the university that fellows can tap into. We also encourage fellows to partner in a research project with a first-year resident, who can continue the research.

While we don’t have strict research requirements, research is important for all podiatrists because it gives you a different perspective; it shows you how medicine evolves.

ABPM: Who is the ideal candidate for this fellowship? What are you looking for?

Dr. Ford: In general, CPME-approved fellowships are great for those interested in academic medicine, or those who don’t feel they got enough experience through their residency.

On paper, we’re looking for the same things as everyone else – good PRR logs, involvement in extra curricular activities, etc. But when it comes to the interview, we are looking for someone eager to learn and who can rise to the occasion. This fellowship is attached to a residency program, so our fellows get a lot of calls from residents – they become teachers. A good candidate for this fellowship won’t shy away from that aspect.

Most importantly, we’re looking for a candidate who knows what they are lacking and how this experience can fill that gap.

ABPM: What else do potential candidates need to know?

Dr. Ford: We send out a notice to all residency programs right after Labor Day. Applications should be submitted by the end of the year.  But we do encourage interested residents to contact us anytime.

Also, because you’re required to be licensed by the state of Kentucky before you can start the fellowship, it’s important you plan ahead. The state exam is normally in April or May.

As dual-boarded DPM in academic medicine, do you have any other words of wisdom?

As insurance becomes more and more important, credentials will become more and more important. So, get dual-boarded. Get the extra wound care certification offered by ABPM. Get certified in whatever you can! In my opinion, it’s easiest to do all this right after residency, when everything is fresh in your mind. Sit for all of it – one right after the other.

 

For additional information about this fellowship, visit http://www.kentuckyonehealth.org/fellowship-opportunities-podiatry-program

Interested Podiatrists may contact Dr. Timothy Ford, Fellowship Director at tcford03@louisville.edu

If you have or know of a CPME fellowship program that you would like featured in this series, please email admin@ABPMed.org

Dr. Marshall Solomon: A Profile of Lifelong Learning

Solomon

Dr. Marshall Solomon

It all started with talking to a close friend who was attending Podiatry school and then shadowing a few Doctors of Podiatric Medicine (DPMs) in his area. It was then that Dr. Marshall Solomon knew Podiatry was the field for him. Now, he’s had a successful podiatric practice – and partnership with former Ohio College of Podiatric Medicine (now Kent State University College of Podiatric Medicine) classmate – in the metro Detroit area for over 42 years.

Looking back over his career, Dr. Solomon encourages residents to get as much clinical and surgical experience as they can during residency. He also recommends getting involved in Podiatric research and continuing education.

“Lifelong learning is the key to professional awareness and happiness,” he said.

Dr. Solomon practices what he preaches. During residency, he authored and published a monograph-text on Biomechanical Radiographic Evaluation of the Foot, which was eventually used by the College of Podiatric Medicine (CPM). His commitment to education began early in his career as he has been a podiatric residency director for over 38 years, and has been involved in clerkship and resident training at Beaumont Hospital Farmington Hills (Botsford).

Dr. Solomon takes pride in his involvement with resident education, and says “It has given me the exposure and experience to see how important it is to integrate the educational goals of our students and residents into our curriculum. This leads to greater competency, and a better professional attitude and judgment.”

He is also involved in state and national resident education – as Chairman of both the Council on Teaching Hospitals (COTH) and the American Association of Colleges of Podiatric Medicine (AACPM).  In fact, he once served as Chairman for both organizations simultaneously. A challenge he says “resulted in meeting some outstanding individuals from various residency programs and college certifying boards. It gives you great excitement to work with similar individuals.”

In addition to his thriving practice, which has expanded to include four partners, and his extensive work in Podiatric education, Dr. Solomon is involved in medical administration at Beaumont Health System and Farmington Hills Hospital, and is a member of the hospital Executive Board and of the Graduate Medical Education Committee for both the hospital and the Beaumont Health System.

Dr. Solomon sat for the American Board of Podiatric Medicine (ABPM) certification in 1992, and is dual certified with both ABPM and the American Board of Foot and Ankle Surgery (ABFAS). He says, “ABPM really looks out for our new graduating DPMs by allowing them to sit for both qualification and certification the same year they graduate. This has a powerful psychological and economic benefit to a young DPM – it can open doors to privileges in our hospitals, and allow for additional professional contacts to help grow a young practice.”

Dr. Solomon also values his many interests outside of Podiatry, and credits his wife Suzanne with opening his world to new friends, and different lands and cultures. They love to travel, including spending time with their two sons and daughter-in-law in Northwest Seattle and Portland. Although they time these visits for the summer months, when there is much less rain. During cold weather, Dr. Solomon and Suzanne also enjoy spending time at their home in Florida.

Dr. Solomon’s words of wisdom are, “work hard to better yourself and your profession. Always be accountable. Give back in your professional and personal life. Try to “pay-it-forward” in any small way you can, and make a difference in whatever you do. If you live by these words, you will have improved our society and our profession.”

ABPM Encourages Those with Diabetes to “Save Your Soles”

During National Diabetes Month, the American Board of Podiatric Medicine (ABPM) encourages people with diabetes to “Save Your Soles” by taking steps toward better foot health.  Nerve damage from diabetes, also known as diabetic neuropathy, can cause feet to lose feeling. Injuries can go unnoticed, which is dangerous because untreated injuries can lead to infection. While up to 50% of patients have no symptoms, neuropathy may cause pain, burning, tingling, and/or numbness in your feet.

“Minor foot issues, such as an ingrown toenail or small cut, can lead to bigger problems for people with diabetes,” said Dr. Sari Priesand, ABPM-certified podiatrist and fellow at Michigan Medicine. “They may not notice that something is wrong until the situation is serious, or there may be no symptoms.”

People with diabetes may also have poor circulation, which can slow the healing process. So infections can worsen, and sometimes, result in ulcers or even the need for amputation. In 2014, approximately 108,000 U.S. adults had diabetes-related amputations.

“Diabetes-related foot issues can greatly reduce quality of life,” said Dr. Priesand. “However, by properly managing your diabetes, making foot care part of your daily routine, and getting checkups, most diabetic foot issues can be prevented.”

The ABPM recommends these steps to keep your feet as healthy as possible:

  • Get checkups. See an ABPM-certified podiatrist at least once a year for a diabetic foot assessment and risk assessment. Depending on your condition and risk factors, you may need to see your podiatrist more often.
  • Check your feet daily. Wash your feet every day and dry them thoroughly. Check for blisters, cracks, redness or sores. If you are unable to check your own feet, use a handheld mirror, or ask a friend or family member to help.
  • Apply a light coating of petroleum jelly or lotion to the bottom of your feet to help prevent skin cracking. However, don’t put it between the toes because it can cause infection.
  • Keep your toes dry. Apply cornstarch or powder between your toes to keep the skin dry.
  • Stop smoking. Smoking restricts blood flow to the skin, which impairs wound healing. Visit the Centers for Disease Control and Prevention (CDC) Web site for more information about smoking and resources to help you quit.
  • Get help. Don’t remove callouses, bunions, corns, or warts by yourself. Get assistance from an ABPM-certified podiatrist.
  • Protect your feet.
    • Always wear shoes or slippers.
    • Pick shoes that are comfortable, have a closed-toe and fit well. If you have difficulty finding shoes that fit correctly, talk to your doctor or podiatrist about prescription diabetic shoes.
    • Avoid pointy shoes.
    • Trim your toenails straight across, and try not to cut them too short.
    • Never soak your feet.

Hospital Appointment and Surgical Privileges Simplified

By Dr. James Stavosky

As a residency director and ABPM Board member, I have noticed some confusion among residents and new practitioners when applying for staff appointment and hospital and/or surgical privileges. The primary purpose of credentialing and privileging is to ensure that a practitioner is competent and meets the education, training and experience required by governing  bodies such as the Joint Commission of the Accreditation of Healthcare Organizations (JCAHO) and the Center for Medicare and Medicaid Services (CMS) . While the application process can be complex, sometimes even inconsistent, below, is a general summary of hospital requirements and what ABPM’s certification means to this process.

Credentialing

To work for, or provide services at, a hospital you will need to provide the medical staff office with your education, training and experience including primary source verification of your DPM degree, state license, DEA registration, residency training and board certification, as part of the credentialing process. Once the medical staff verifies this information, it typically goes to the Medical Executive Committee who reviews the material and approves you r appointment to the medical staff of the hospital.

There are various levels applied to the medical staff.  You may begin as “provisional staff” until you’ve been at the hospital and attended medical staff meetings for a defined period (6 months or a year); then, depending on your level of activity at the hospital you may be promoted to “active staff”.  Hospitals also have a “courtesy staff” designation for individuals who are not regular providers of services in the hospital.  As a member of the medical staff, you may be required to pay annual dues and attend meetings.

Privileging

Once on staff, you apply for privileges. While every podiatrist completes similar education (podiatric medical school and three years of residency training), experience is the differentiating factor for privileging.

Experience matters

Case logs will be used to determine your level of privileges.  During residency you may have met minimum case requirements for the Council on Podiatric Medical Education (CPME) but some residents will have experience beyond minimums in, e.g. trauma, diabetic foot and/or reconstruction. Privileges for podiatric surgery vary from hospital to hospital because of state law regarding scope-of-practice, as well as how the hospital bylaws are written. Some podiatry privileging forms are more simplified, granting core privileges (hospital admissions, consults, basic surgeries) and then privileges for advanced procedures in groups.  Other processes for privileging may require that each procedure be individually requested (e.g. 15 different types of bunions).  If you don’t have the case volume to receive privileges for a particular procedure, the department may require proctoring of a certain number of cases before those privileges are granted.  This is also true if you already have privileges and request to do a newly learned procedure.

Podiatry or another department?

Podiatry may be in its own hospital department or under another department such as surgery, vascular, plastics or orthopedics.  The department chair runs the privileging process.

ABPM Board Certification

Board certification is only one component of hospital credentialing and privileging.  The Council on Podiatric Medical Education (CPME), through the Joint Committee on Recognition of Specialty Boards (JCRSB) recognizes two certifying boards:  The American Board of Podiatric Medicine (ABPM) and the American Board of Foot and Ankle Surgery (ABFAS).

ABPM’s primary duty is to protect the public by ensuring the competence of those applying to become board certified.  Podiatrists completing a 3-year, CPME-approved residency, may take both the ABPM qualification and certification examination the year they complete their residency. We encourage you to maintain well-documented, thorough logs so you can show your experience and provide these when applying for credentialing and privileges, but they are not required for ABPM certification.   This requirement was lifted a few years ago after extensive correlation analysis on the pass rate by those with appropriate case documentation, making submission unnecessary. Since hospital bylaws generally require you to become certified within 5 years of residency training or lose your staff appointment, we encourage all podiatrists to take both the ABPM qualification and certification examinations in the year they complete their residency. .

Yet remember, your surgical privileges are not based on your certification alone, but on your education, training and experience; This is why ongoing case documentation and logs remain important.  Hospital departments that specifically require ABFAS certification for surgical privileges may have included this at a time when podiatric education was not standardized and did not include the level of education and residency required of today’s podiatrists.  These may require updating.  ABPM can assist hospital credentialing and medical staff offices with privileging language that is compliant with the requirements of the medical governing bodies.

If you have experienced any challenges in obtaining privileges or have any further questions, please contact Dr. Marc A. Benard, ABPM’s Executive Director, who will initiate a review of the situation to assist you however possible.

 

 

 

The American Board of Podiatric Medicine
1060 Aviation Blvd., Suite 100
Hermosa Beach, CA 90254