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Glad you asked those questions, Thomas... Thomas, here are my answers to the excellent questions you pose: QUESTION: Will hospitals and insurance companies recognize this new training? ANSWER: Probably. It would depend upon a number of factors. Consider this: the only reason they recognize the ABPS and PSR residencies is because of aggressive marketing and PR by the ABPS. It isn't because of any inherent superiority of PSR programs--we all know how variable those are in quality. After setting up a legitimate independent organization to develop and accredit these training programs--and it WOULD be legitimate, enemy propaganda notwithstanding--the level of recognition it would be able to achieve with hospitals and insurance companies would depend upon how aggressively we do what the ABPS has done: marketing and public relations. It would also depend, at least to some degree, upon the board certification tie-in we are able to make. If we can get the programs recognized by the American Podiatric Medical Specialties Board as qualifying graduates to sit for their certification exams, for example, that would significantly enhance credibility and acceptance. The APMSB is already accepted by many managed care organizations on an equal basis with the ABPS--no doubt to that organization's disgust and dismay. Having our programs accredited by the same independent, nationally recognized organizations that currently accredit the APMSB, and having them accepted by the APMSB as qualifying graduates to sit as candidates for board certification, would go a long way toward solving the recognition problem, at least with the insurance plans. As to the issue of hospital recognition, that is a thornier problem. I anticipate that most of the resistance we will face on that front will come from the very same ABPS podiatrists who are currently back-stabbing colleagues to keep them off staff. To resolve that problem will require both numbers (ie, lots of podiatrists, blocked out by the ABPS and screwed out of access to meaningful board certification by selfish bottom feeders among our so-called "colleagues", choosing to pursue our programs and obtain their board certification through our pathway) and the will to fight, in court and in the media if need be.
At many hospitals across the country, please note, staff membership and surgical privileges are still available to
non-PSR and non-ABPS podiatrists. In addition, many PSR-trained, ABPS podiatrists are fair, reasonable, and
supportive or colleagues, so far refraining from seeking the imposition of unreasonable, restrictive bylaws. If we
act in an expeditious fashion and get our own people on staff at such hospitals, and network with the "good
guys", we can ensure that they REMAIN open.
ABPS propaganda is only effective when it is unopposed. I assert that by creating programs and an organization
such as I've proposed here, we can mount an extremely credible and effective opposition to that propaganda,
and put an end to their stranglehold once and for all. QUESTION: Will this program ultimately lead to a competitive organization to the APMA? ANSWER: This program seeks to create a new, open, fair training and board certification pathway, and thus would lead to a competitive organization to the ABPS. It does not create a new representative organization for the profession, and so would not compete with the APMA.
At the risk of opening up a can of worms here, I suggest that such a competitive organization to the APMA
already exists, in the form of the AAPPS. I further suggest that it is in the best interests of everyone reading
this--students, residents, and all recent graduates and established podiatrists affected by the selfish and elitists
policies and activities we are seeking to circumvent --to join and support the AAPPS in preference to the APMA,
as well as to establish state-level affiliates with the AAPPS.
While the AAPPS is not flawless, it is established and organized, providing the necessary nucleus for a viable and
effective counter to the APMA. One of the founding principles of the AAPPS is that all podiatrists have the right
to complete training in the full scope of podiatric medicine and surgery, the right to practice the full scope of
podiatric medicine and surgery, and the right to become certified in all areas of podiatric medicine and surgery
based solely upon demonstrable knowledge, skill, and clinical judgement--it already recognizes those rights that
we seek to protect.
All that it lacks is numbers. As a result of its small size, turn-over in its organizational hierarchy has been minimal.
All it needs is greater membership, with an influx of "new blood" interested in being involved, to completely
establish it as an effective and powerful counterpoint to the APMA.
If you are a member of the APMA, your membership serves as de facto support for all its policies--including
those that currently cut you off from full-scope training and fair, open access to board certification in all areas of
practice based upon individual qualifications rather than residency program initials--regardless of your personal
views. Your membership and dues with the APMA are used to take and support actions and policies that are
diametrically opposed to your own needs and interests.
My own time in the APMA and its state-level affiliate here in Indiana taught me well that they are NOT
democratic bodies in any meaningful sense of the term. In general, officers rose through the ranks by a peculiar
form of rite of succession, rather than by free and open elections--or "earned" their way up the ranks, as some
in
the "in-crowd" would have it. They were selected based in large part upon their acceptance of and support for
the status quo.
If anyone can convincingly demonstrate that this situation has changed for the better, then please respond
here--just the facts, please, and leave any "parasite" and "traitor to the profession" bullsh*t at home. Barring this,
it must be obvious to all that individual participation in the APMA is not significantly meaningful, and the By working on the outside, building and consolidating an organization such as the AAPPS, we have the opportunity to accomplish a great deal. First, we can effectively shape an organization that already largely represents the ideals of equality and a level playing field that we espouse. Second, we can build an effective and powerful organization to counter the actions of the APMA and its affiliates, preventing them from ramming their elitist-created policies and restrictive training and board certification systems down the collective throats of this profession. Third, by taking the "new blood" of this profession, we can exert tremendous pressure on the APMA and its affiliates to institute meaningful changes to address our legitimate concerns, needs, and demands--they would have no choice, as to do otherwise would be to condemn themselves to wither away and die as organizations, as the new podiatrists entering this profession secure membership in alternative organizations which provide the level playing field that is critical to survival, and that better represent their needs and opinions. I will expand upon the issue of the APMA in a future "Lemons" series post. QUESTION: Could it compete? Will the best trained podiatrists avoid this program so as not to anger the APMA and ACFAS? ANSWER: Yes, I believe it could compete. To be more accurate, I believe that the new training organization, the APMSB as a legitimate and meaningful alternative to the ABPS, and the AAPPS as a meaningful and legitimate alternative to the APMA could all compete, and very effectively. All that is needed is numbers. And all that is needed for the numbers to be generated is for the students of today, the residents of today, and the podiatrists already out here in practice and struggling under to adverse circumstances and limitations imposed upon them by the APMA and its affiliates to face reality and come to the realization that their best interests, both as individuals and as a collective, are best served not by joining the APMA but by opposing it. Many individuals, it must be noted, refrain from doing so for fear that they would be undermining the profession. Nothing could be further from the truth. In point of fact, one can serve this profession just as well and just as faithfully outside the APMA as inside--indeed, I would contend that outside is better and much more effective.
As to whether or not the best trained podiatrists would avoid this program for fear of offending the APMA, the
ACFAS, or the ABPS: who knows? Some would, which frankly should come as no surprise--they are the same
people who are turning their backs upon their colleagues now, and who want to see the current situation
continued because it advantages them personally by eliminating thousands of podiatrists from effectively
competing.
There are many well-trained podiatric surgeons out there, however, who are willing to share their skills and
experience with others now, and who would no doubt be willing to share them in the future with people in a
program such as the one I am proposing. Also keep in mind that an endless supply of "the best trained podiatrists" is not necessary. One of the ultimate goals of this program is to make it entirely self-sustaining. After a relatively brief period of years, the majority of mentor/instructors in the program would be drawn from those who themselves completed the program. So the short form of my answer is: screw the APMA, the ACFAS, and the ABPS. We don't need them. Period. QUESTION: Is this just a lovely dream or is it really possible?? ANSWER: You tell me. In fact, how about EVERYONE out there tell me? How hard are you willing to work to make a program like I've proposed here exist? How badly do you want such a training program to be available to you? What are you willing to do RIGHT NOW to make it happen? Are you willing to get out and pound a little pavement to locate well-trained podiatrists in established, successful practices who are willing to share their skills and experience by training others, thus building our initial core group of mentor/instructors? Are you willing to have an active hand in putting together the organization to develop the training program, working out its basic structure and ironing out the "kinks" that will undoubtedly reveal themselves in the early years? Are you willing to work to get this program accredited by the NCCA/NOCA? To get the program recognized by the APMSB so that graduates would be eligible to sit for board certification in all areas of practice? To advance recognition of both this program and the APMSB by hospitals and third-party payors? Are you willing to share you skills and experience with newcomers in a fair, free, and open manner after receiving your training and credentials, by becoming part of the mentor/instructor pool yourself? Are you willing to tell the APMA and its affiliates to "stick it where the moon don't shine" and work to build an alternative organization like the AAPPS into an effective and powerful competitor? Are you willing to take some risks, in order to secure the rewards you seek? The APMA, the ABPS, and the elitist special interests they represent will oppose this--are you willing to face that opposition and fight hard to defeat it? Doing all of this won't come easy--it will exact a price from each of us who are involved in creating this program and getting it established, or building and strengthening an effective alternative to the APMA.
Are you willing to pay the price?
John L. Trench III, DPM The above represents my personal views and opinions. Please forgive any typos or errors in grammar, as I'm typing "on the fly" here. |