LETTERS TO THE EDITOR
***Podiatry Unions***
Here's a very interesting article on legalities of Physician unions. I am researching the feasibility of starting such a guild. Would you or your magazine have any interest in participating in a group to brainstorm the formation of such an entity?
Steven Warshawsky, Administrator
Neuropathy Institute of Southern California, Inc.
EDITOR’S RESPONSE
I took a look at this article online and found it very educational. I had actually considered writing an editorial on the subject. However, as I'm only poorly educated on the subject I'll let our readers review this on your own.
—Jarrod Shapiro, DPM
***Board Certification***
I am a little confused by one of the comments made regarding board certification:
>2. You have to be in practice for 3 yrs before you can apply for the certification.
I have read the ABPS 110 document which makes no statement as to how long you must be out in practice in order to be certified. I believe it states that you must have 4 years of clinical experience after you have acquired the DPM degree. Which means that in order to sit for the 2008 exam you must have graduated school and begun residency by 2004.
I have been in practice for 1.5 years now. I would have submitted for the board certification this year, but unfortunately I missed the deadline this year due to loosing track of time and not paying attention to the date the application needed to be in. I will plan on submitting next year. If the 3 year rule were true then I would not be able to sit for boards this year or next year.
The other point to add regarding certification is to consider your employment contract. Although it is true you have 7 years to become board certified; some employers will require you become certified sooner than this allotted time. For example, you must be Board Certified within 5 years in order to work at Kaiser Permanente. Obviously in these types of contracts acquiring case numbers usually is not an issue.
Sincerely,
Kenneth Lopez,
DPM
Kaiser North Bay Consortium
Kaiser Santa Rosa
EDITOR’S RESPONSE
I rechecked the CPME 110 document and Dr Lopez is absolutely correct regarding the experience required for certification. Here’s an excerpt from the document. My apologies for allowing this mistake to pass through to publication. That’s why this is such a useful forum!
"Clinical Experience. Four years of post-DPM degree clinical experience must be completed before taking the certification examination. All candidates must have received the DPM degree by June 2004 to sit for the 2008 examination" (ABPS document 110, page 2).
Dr Lopez is also very correct about the requirements for certification for certain jobs. This is often true for community hospitals. Many hospitals will allow new physicians on staff with the agreement that they will be certified within a certain time frame, 5 years in my experience.
—Jarrod Shapiro, DPM
***A Word on MRSA***
Recently I emailed Dr Warren Joseph an antibiotic/MRSA question after watching his lecture on PRESENT Courseware entitled Diabetic Foot Infections. I found his response fascinating and informative. If you don't know who Dr Joseph is I'd recommend reviewing his lectures on the PRESENT Courseware website. He's a national expert who has an engaging informal lecture style. Read on and be educated…
Shapiro's Question:
In my local hospital I've been seeing a lot of admissions for diabetic foot infections placed on a beta-lactam inhibitor + Vanco. Apparently they are covering for MRSA before actually knowing if it's an infecting organism or not. We seem to have a relatively high MRSA percentage (~50%). They're also doing swab cultures of the wounds! Unbelievable. This adding Vanco under the assumption of MRSA presence seems ridiculous to me. Do you have any thoughts on the subject?
Dr Joseph’s Response:
What you are seeing is a very common situation. Most US hospitals are showing an MRSA rate of 60-70%. For this reason empiric therapy usually includes anti-MRSA drugs. The combo of something like pip/tazo + vanco is what I usually see being done. That being said there is really no evidence to support the practice. Most of the MRSA found in hospital antibiograms comes from the ICU, not necessarily skin and skin structure infections.
Furthermore, even if it DID come from SSSI the evidence is pretty strong that you don't need to treat it as an infecting organism. There have been numerous papers on this topic (Fridkin, NEJM. Chambers, NEJM. Moran, NEJM.Dang, Diabetic Medicine - looked specifically at DFI, etc.) In fact, one recent paper published in Clinical Infectious Diseases looked at SSSI and compared cephalexin to placebo. Guess what, despite >80% of infections being caused by MRSA the placebo had a >90% clinical success rate! So, the bottom line is that the addition of anti-MRSA therapy is not supported by the literature.
All of this is well and good but most docs are so afraid of NOT covering MRSA that therapy is added no matter what the evidence shows. Patients, TV stations and Attorneys are all very keen on MRSA at this point.
IF you are going to cover MRSA, I really think that the evidence shows that vanco is a drug for the history books and not appropriate therapy anymore. In fact, I direct you to an interesting point-counterpoint piece published about a year or so ago in Clinical Infectious Diseases by Stan Deresinski entitled something like "Vancomycin for MRSA: An antibiotic enters obsolescence." There are many newer, much more effective drugs for MRSA.
—Warren Joseph
[email protected]
***Board Certification***
I recently read your response about the boards, and just had to respond. I have been in practice for 21 years and completed a surgical residency program in 1986. I became ABPS certified in 1989 and ABPOPPM certified in Orthopedics in 1990 and Primary Podiatric Medicine in 1993. ( In the past there were 2 certifications, now there is just one that tests both areas.). I also became a BCP (board certified pedorthist) in 2006. I was president of ABPOPPM from 2005-2007. I've been an oral examiner for ABPOPPM for the last 15 years.
The Boards that ALL NEW Podiatrists need is BOTH Boards and any pertinent certification that raise the individuals aptitude to the highest level. Every PMS 24 or 36 resident can take both boards. The facts are that the average podiatrist does 20 percent surgery, that is national data.
My question to you and other young Podiatrists is why do they not see the value in ABPOPPM certification, when the majority of what they will be doing is non surgical? There are many reasons for being dual boarded. We as a profession have strived for comprehensive training---why would anyone not want comprehensive certification? Are they not concerned about how that lack of certification might be brought up in a law suit and how it might be protective? Do they not want to hold the highest level of certification in Podiatric Orthopedics and Primary Podiatric Medicine?
This profession defined the specialty areas and the CPME recognizes both boards, and for years now I have been perplexed by the casual attitude I see in many young Podiatrists when it comes to ABPOPPM.
I am not a lawyer, but if I was, and I new there was a board in Podiatry that certified in non surgical areas of Podiatric Practice and had a case that involved a non surgical area I think I would be in a very good position. That alone as a Podiatrist would and did make me hop to it. It also made many of my colleagues do the same.
In summary all I will continue to hope that young Podiatrists will value the body of knowledge of those Podiatrists from the past who never did surgery or very little of it but revolutionized much of biomechanical landscape we know today. Let me also say I very much value my surgical training and certification but there is more and every day I am reminded of that by the patients treat. This is a great and diverse profession but has many parts.
Jerry Saponara
[email protected] |
