2014 APMA Young Physician Survey Survey Fall 2014 BOT.pdf · 2014-11-20 · 2014. 2013. 2012. 2011....

2014 APMA Young Physician Survey

September 2014 281 Respondents

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

0.0% 5.0% 10.0% 15.0% 20.0%

Podiatric Medical College Graduation Year

Male

Female

0.0% 20.0% 40.0% 60.0% 80.0%

Gender of Respondents

Male

Female

RPR

POR

PPMR

PSR-12

PSR-24

PM&S-24

PM&S-36

PMSR

PMSR/RRA

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Post-Graduate Training Completed or Currently Completing

1 year

2 years

3 years

4 years

5 years

6 years

7 years

N/A

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

The Number of Years in Practice if Post-Graduate Training is Complete

99 out of 281 respondents (35.2%)

Solo

Small group (2–5 podiatrists)

Large group (6–20 podiatrists)

Super group (21 or morepodiatrists)

Multi-specialty

Academic

Hospital system

Federal (e.g. DOD, VA,IHS, etc.)

Other

Not applicable

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

Current Practice Type

Residency or Fellowship

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

Less than $50,000

$50,000–70,000

$71,000–90,000

$91,000–110,000

$111,000–130,000

$131,000–150,000

$151,000–170,000

$171,000–190,000

Greater than$190,000

Not applicable

Annual Salary if in Practice

Residency or Fellowship

.00

5.00

10.00

15.00

20.00

25.00

Pal

liativ

e

Wou

nd c

are

Foo

t – s

urgi

cal

Rea

rfoo

t and

re

cons

truct

ive

– su

rgic

al

Bio

mec

hani

cs

All

othe

r (pe

diat

rics,

spor

ts m

edic

ine,

etc

.)

Division of Practice

Yes

No

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

Did you attend the APMA 2014 Annual Scientific Meeting (The National)?

Yes

No

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Con

tinui

nged

ucat

ion

cont

act

hour

s

Cos

t

Pee

r net

wor

king

Loca

tion

Pra

ctic

em

anag

emen

t rel

ated

mat

eria

l

Han

ds-o

nw

orks

hops

Reasons For Attending the 2014 ASM

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Location Meeting cost Meeting agenda Time away notpermitted by

residency or practice

Reason For Not Attending the 2014 ASM

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Orlando 2015 Philadelphia 2016 Nashville 2017 None Unsure

Future Planned ASM Attendance

Other (including research)

Biomechanics

Wound/dermatology/nails

Medicine (includingendocrinology,…

Practice Management

Surgery 32%

23%

15%

11%

14%

5%

Topic of choice for the ASM

Topics Surgery

• Charcot reconstruction • Calcaneal fractures (and use of delta frames) • Total ankle replacements vs ankle arthrodesis(4) • Fractures (comminuted and non-unions) (2) • Surgical treatment algorithm for hallux limitus/rigidus and outcomes based literature (6) • 2nd MTP joint pathology (including the mini scorpion and viper techniques) (3) • Neuromas • Surgical flaps • Ankle and pilon fractures (2) • Hind foot (2) • Flat foot reconstruction (including initial and revisional repair AND tendon advancement and

arthroreisis) • Surgery - innovations and complications (4) • External fixation • Surgical management of OCD (2) • Rheumatoid foot reconstruction • Peri-operative medical management of the surgical patient • Limb Salvage • Minimally invasive techniques • Tendon repair • Tendon transfer for forefoot rebalancing s/p TMA • Ankle Arthroscopy (3) • Surgical techniques that may assist in closure of dehisced incisions/wounds (i.e. DermaClose, tissue

expanders) • Preoperative evaluation of pediatric and adult flatfoot • Tarsal tunnel surgical management • EBM-driven wound care and surgical management (2) • Trauma (adult and pediatric)

Topics Practice Management

• Back to basics. With changing healthcare, surgery is the same and I will go to ACFAS to learn about that. The APMA has a great opportunity to differentiate from ACFAS by focusing on the basics that make us money.

• Reimbursement/Billing and coding (3) Common young practitioner billing mistakes Medicare billing for palliative care

• Practice management (3) Practical practice management for new practitioners. I have been to the practice management assoc. meetings and

the whole conference was trying to sell the APMA coding resource. This was unhelpful. I need instruction, not an infomercial.

There should be courses specifically for young doctors that takes them through coding/ billing, office management, time management, all the governmental requirements etc.

• How to survive making $100,000 while repaying student loans (2) • Jobs after residency and what to expect (3) • Lawsuits, how to avoid them • Starting a practice/partnership • Practice purchase • Liability/asset protection • Changes in healthcare affecting our profession • There should be courses specifically for young doctors that takes them through coding/ billing,

office management, time management, all the governmental requirements, etc. • Salary and job seeking stats, employment models, etc. (2) • Financial planning (2)

Topics Biomechanics

• Biomechanics (2) • Orthotics

Research based evidence proving the efficacy of custom molded orthoses Proper posting positions with orthotics

• Review of specific shoe gear Shoe selection in athletes

• Gait analysis • Pediatric biomechanics

Pediatric casting technique

• Biomechanics of athletes and child athletes • AFO fabrication • Utilization of pedorthist vs. podiatrist for bracing devices

Topics Wound Care, Dermatology, Nails

• Current updates in wound care (2) • Onychomycosis/Tinea (2) • Head to head comparison of wound care

supplies/dressings/biologics and applications based on wound type (2)

• Ulcer Offloading • Skin cancer • Pyoderma gangrenosum • Dermatology (2) • New dermatological practices • How social factors influence patient outcomes in

wound healing

Topics Medicine

• Diabetes • Effects of common endocrine and metabolic diseases on the body and

also the lower extremities (e.g. thyroid disease) • Diabetic Nerve Pain/Neuropathy (2) • Evidence based medicine (2) • Multiple sclerosis • Venous insufficiency • Small vessel disease treatment options • Updates on diabetic foot • Diabetes and depression and its relationship to wound healing rates • Tarsal tunnel syndrome • Plantar fasciitis and differentiating heel pain (2) • Sports medicine • Manipulation • Pain control • Cost effective management of DFI • Antibiotics, Diabetes Rx, Anticoagulant Rx, etc. update

Topics Other

• Future of podiatry • Case studies • Residency shortage • Boards certification preparation (2) • New products • Uniform training across the country • Communication barriers & cultural sensitivity • Curbing non-compliance

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

BQ ABPM BC ABPM BQ ABFASfoot

BQ ABFASRRA

BC ABFASfoot

BC ABFASRRA

I am not BQ orBC in any of

thesecategories

Board Qualification and Certification Status

Met myexpectationsas fair andobjective

Did not meetmy

expectations

Unsure

I did notparticipate

0.0% 20.0% 40.0% 60.0% 80.0%

Your experience with the ABPM BQ or BC examination process if taken in the last two years

If the ABPM board qualification or board certification process did not meet your expectations, please explain.

• Although I felt it was mostly fair, some pathology on the test were very complex and not common day presentation.

• There is no feedback on failed sections of the exam. These would be incredibly helpful for retaking the exam. Also, the results were not available in 6-8 weeks as promised. It took 3 months to receive the results, meanwhile I am trying to verify qualification status for hospital privileges. Unacceptable.

• It was not as difficult of an exam as I thought it would be. I felt like any middle of the road 4th year student should be able to pass that test.

• Poor wording on exam. Poor image quality. • No good training or study material for the boards. Its read McGlamry’s or

go to one of 2 conferences. And there should only be one board certifying body we shouldn't even allow other certification bodies.

• The exam requires "picking the best answer" and is graded by someone who has his/her own bias for what is the "best" answer. The "best" answer does not reflect what is practiced really in real life scenario.

If the ABPM board qualification or board certification process did not meet your expectations, please explain.

• Several exam questions had errors or were poorly written. The imaging pictures were small and blurry and one question states to look at the MRI below and there was not one there.

• Exam was terribly written • The computer based portion is not a great representation of our

knowledge. • Felt that the exam did not reflect the current practices of our profession • There were some spelling errors/typos as well as formatting issues with the

exam. • I felt the questions did not cover all topics. I had several questions that

were the same. Many orthotic/biomechanical questions contained terms not found in study references.

• There were a lot of general medicine questions • The test was terrible. the exam froze in the middle and skipped questions

during the "practical" section. I had to retake the test due to so many glitches.

• Not worth it • The CBPS portion of the exam is very confusing.

Met myexpectationsas fair andobjective

Did not meetmy

expectations

Unsure

I did notparticipate

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Your experience with the ABFAS BQ or BC examination process if taken in the last two years

If the ABFAS board qualification or board certification process did not meet your expectations, please explain.

• Too many people fail the exam. Not sure what is wrong but something is wrong with the process.

• There are many amongst my well trained colleagues that do not have confidence or trust for the ABFAS.

• Many of the people I know who recently finished quality residency programs around the country did not pass all portions. I don't think it's due to poor training, I think it's due to poor examination design.

• Too focused on misleading student doctor • Regarding the CBPS portion of RRA Part 1, the time limit was much too

short for proper evaluation. • This is in regards to the qualification exams: Applying for the exam was

difficult (first the website was under construction). .) Upon taking the exam it said that results would be mailed in 4-6 weeks, but it really took 12 or more for the results to be mailed. ABFAS would not answer any questions over the phone regarding when results would be sent or what they were prior to 12 weeks. Upon finding out failure, they sent a very vague explanation of my score (which was final and again they would not answer any questions over the phone). The adaptive questioning system is flawed, in that if you miss a question deemed to be "easy," it will continue to only give you "easy" questions which are worth less points. There needs to be more clarity and more transparency with regards to these boards.


• CBPS questions were poorly designed • Scam to take your money. Failing rate too high...board prep is a joke • The selection of cases did not seem to be well organized. After the test final results

were not given until weeks after the initial deadline had been given and no formal letter was received until MONTHS later. This poses serious problems for young physicians as hospitals begin asking what the results of the test were for credentialing purposes.

• I don't agree with the quantity of rear foot specific BONE cases needed to sit for board certification. I feel the number is high in regards to fusions and osteotomies, etc.

• instructions as to how the computer base questions are graded is very confusing. One instructor told me to use all possible number of responses of every question while another instructor says you will be penalized if you use all 10 or 20 selections granted by the exam.

• Poorly written questions. • Very confusing question types and need more practice on pt simulator portion of

exam • This process is ridiculous and going to kill our profession. No one even knows what

the current criteria are for getting to sit for the certification exam!!!!!!! • Case based portion poorly designed. • Poor image quality.


• Very poor experience with the computer based testing, computers freezing, not fair at all.

• The changing of standards without prior disclosure was greatly upsetting. • Not very realistic or representative of true day to day podiatry. Too much

"gray" area in terms of questions and answers to pick from. • I found that my peers and I didn't pass the board qualification, and I

actually did the Goldfarb class. It just seems the tests are so subjective and the testing process is a pyramid scam.

• The exam requires "picking the best answer" and is graded by someone who has his/her own bias for what is the "best" answer. The "best" answer does not reflect what is practiced really in real life scenario.

• Exam is not relevant • I feel the test is not appropriate for minimal competency. It does not look

good that the failure rate is so high. In an era when we are striving to prove we are competent physicians, we can not have a failure rate higher than the other specialties


• The exam instructions are vague. There are no scoring guidelines for the CBPS portion. Speaking with a member of the ABFAS, I was told there really is no way to prepare for the CBPS section.

• I did not find the CBPS to be an objective examination of my skills and knowledge. It is also the reason why I am not yet BQ.

• "administrative staff- difficult to reach with questions • -website is not user friendly" • New generation of surgeons should revamp the process • poor worded, bad quality pictures, • The testing made for a very long day and I do not feel like it is a good representation of

our knowledge because of how long the testing day is. • the radiology views were awful and half the questions were too nonspecific to properly

answer the questions. too much medical not enough podiatry. in the practice we don't spend as much time focusing on that as we know our legal limitations.

• I thought the process was unorganized and unprofessional. Policies were not consistent and results were delayed with computer complications causing unneeded stress and anxiety for the participants.

• I feel the test is not appropriate for minimal competency. It does not look good that the failure rate is so high. In an era when we are striving to prove we are competent physicians, we can not have a failure rate higher than the other specialties.


• The exam is more concerned with technique than actual knowledge. Does not resonate in the real world.

• Results greatly delayed and poor explains of any questions asked through out process. Rumors or greater than 50% failure of at least on section.

• Examination largely not representative of current practice standards and inclusive of common pathologies. Exam was riddled with things that are rarely, if ever seen.

• The organization of the drop down menus is horrible. Words are not similar which makes searching for them difficult (i.e., non union and nonunion). Massive redundancy in the procedure checklist is not needed. The computer test is not a test of knowledge. I passed simply because I studied the drop down menus.

• The volume of surgeries required is high. I practice in a rural area with lower volume of surgery. We should be certified within 1-2 years of being in practice. This would be more consistent with other surgical specialties.

• Exam not reflective of current practice, poorly designed


• Extremely slow to respond to any communication. Delay in scoring resulting in multiple hospital privileges denied. Lost paperwork and delay with qualification.

• Not a good representation of competence • Case submission process was not organized and unfair • Difficult to prepare for, not very concise. • My colleagues will tell you that it was the hardest exam we have ever taken. I think

there is something wrong with the exam process when only 50-60% of people actually pass the first time.

• Patient simulation section was poorly organized and did not truly test the physicians knowledge or skills.

• Met my expectations but I do not feel it was fair or realistic. • Unfair that people had different questions. • I failed the RRA exam by 10 points. I am not sure what I missed on the exam

because the scoring rubric was poorly put together and did not make sense at all. They also took 3 months to get me the results when I was trying to get on staff at a hospital. The test questions were also very subjective and like nothing I studied in a book. It is apparent they were written by Podiatrists and not PhDs, Podiatrists do not know how to write board questions.

01234567

Priorities

AA

PPM

AA

PSM

AA

WP

AA

HH

P

AC

FAO

M

AC

FAP

AC

FAS

APM

WA

APH

A

ASP

D

ASP

M

ASP

S

AEN

S

SVS

Non

e

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Additional Membership

23%

5% 5%

15%

1%

68%

1% <1% 3%

12%

1% <1%

19%

• Regret going to podiatry school and taking on the debt which I did to do so. Currently feeling like I’m trapped and pondering other careers.

• Forgiveness and leniency for female podiatrist who are starting a family and practicing part time • There should exist a national podiatric license. Some of these state requirements and fees are ridiculous.

Also of great concern to me is the nature of older podiatrists treating young new podiatrists as indentured servants. Too many job interviews offered stipends less than a resident’s pay? I get the parity issue with regards to other medical specialties, but this should not be an issue within our own profession.

• Would like to see more PODIATRY rotations and less non-podiatry rotations during residency. • Coding • Can we address the fungus fest that is JAPMA? How do you have a journal that only has 1 article on

bunions in the past 3 years? • What happened to Vision 2015? • The APMA and ACFAS split is a joke ACFAS is great for surgery but they are so one sided and don’t have

any experience at DC like the APMA. Yet APMA is old and unrelated to modern Physicians but nobody defends podiatry like APMA. The split is dumb and I am sure it’s a matter of pride. Unfortunately, APMA will loose in the future because all of the young ones are more involved in ACFAS, good effort in trying to recruit young members that’s exactly what it will take

• APMA should advocate for loan repayment for podiatrists serving in underserved areas. Similar to that which is offered to MD’s, DO’s, PA’s, DDS’s, DMD’s, and dental hygienists just to name a few.

Is there anything else that APMA should know about you? Do you have challenges that are unique to you as a young physician? Are there any other concerns that you would like addressed?

• It’s always the same challenge for the young physician coming out. The older podiatrists are screwing the younger ones and abusing them physically and financially. The worst enemy in our profession are ourselves. We stepped on each other in order to make more money and make each other look bad. It’s pathetic and disgusting.

• The lack of available options for student loan forgiveness. • For the second year in a row, I have been unmatched. I am a graduate under duress and with unique

circumstances regarding health and family. I am open about this, and I do not use it as a “crutch.” If the residency shortage is not fixed in the near future, I will have no choice but to leave this profession and recommend others in my situation to do the same.

• We need a real board review course for APMLE part 1, part 2, and part 3 with practice questions, question banks and detailed explanation to why each answer choice is right and also the other ones are wrong. Like the USMLEworld.com online for the MD’s but geared for DPM’s.

• Getting insurance plans as a provider. Most are closed in NY • If we are to have parity, then we need 6+ months of internal medicine. • I am a graduate form class of 2013 and I do not have a residency. I have not offered any interviews

from any scrambling programs. I completed school with a 2.8 gpa and passed all the boards. However, I’m not getting anything. CPME is not doing anything. Can’t work because if I work somewhere else, I would never have time to visit programs for next cycle. I’ve worked several different podiatry offices but those were free. There was a possible residency spot for me but the attendings involved in the program hated the guy who was appointed as director. So, they screwed him at the last minute before CPME came to visit the hospital for final approval. Therefore, the program was cancelled. I am also a non-US citizen. I can’t maintain my VISA status anymore. All my time/efforts throughout past 6 years are about to become nothing. Nobody really has solutions. Who is really trying to save us? No one is moving. Everyone is saying it will pass, as well. But there are so many people struggling financially and mentally.


• What type of jobs to expect after residency • I took some time off of practice in my four years since completing residency-

moved and had baby. My employment thus far has not offered a lot of surgical experience. I’ve lost confidence in my surgical decision making and am not on track with cases required to achieve board certification. I’m concerned this will close a lot of doors for my career future.

• Why is starting income for podiatrists out of residency so much lower than other specialties? It seems there is a trend to offer lower salaries starting out and having to work up to what you are worth over a few years where in others specialties you start out with higher base salaries.

• Becoming insurance providers, what memberships are available to us • Why can’t BC/BQ only be obtained through written examination? What really does

oral examination prove? There are many who are BQ and are horrible at surgery • My challenges are being full time DPM, mother of 2 toddlers and wife. Skills to cope

with stress would help! • Buy ins for young physicians. Things have changed since the “great recession” in

2008 with regards to lending, even for physicians. APMA could offer better guidance on young physicians buying into a business.


• Why are there SO MANY different organizations?! They all have different membership fees. I think we need to move away from over compartmentalizing our field in both the educational and professional aspects.

• Make our profession better in the eyes of the public! • More information regarding coding and billing, financial planning • I’m currently a resident. I have a concern for education process and student

selection at schools. There are too much variation between schools concerning classes and courses/rotations. Residency shortage is an embarrassment to the profession. I always have to correct people who are not familiar with podiatry that we do surgery and biomechanics of lower extremity; we are more than toenails and callus. Better marketing and image to the public. I see too much shoe podiatrist images being placed in the public’s eye.

• I would greatly like to see the ABPM certificate accepted by hospitals as a form of certification, other than ABFAS. Unfortunately, I still don't understand how a general surgeon (my best friend is a general surgeon) can achieve certification without doing a single case, but we have to perform a certain number of bunions to achieve surgical certifications. And on top of that, we continue to change what is needed for certification. I find myself practicing to achieve certification instead of practicing to help my patients. This should not be the case.

• Closed insurance panels for new providers.


• Critically evaluate the effectiveness of each residency program's director. Are they really achieving goals? Are they doing what is necessary to promote our profession?

• The annual meeting needs to be changed - not a very strong meeting. Work to create collaboration with ACFAS - we need to step up and mend the fence.

• There needs to be more emphasis on political action and less emphasis on parity. Schools are taking too many students.

• The schools should be held accountable for the number of students that they admit, knowing that they do not have the residency positions to place them.

• I wish that the APMA would make our education mean something, that if we wanted to continue training and learning the schooling meant something, this could easily be accomplished with partnerships with universities that would accept our credits, etc.

• Board Certification pathway needs to be addressed • No, just send some help to Massachusetts this state has horrible podiatry culture. • Not forcing all graduating students to become surgeons. Many of my classmates

have no business in the OR.


• Practicing in rural America when training was done in an inner city. It is an entirely different culture. It would be great to have speakers discuss going to school /doing residency in a big city and then practicing in a rural area.

• Somehow the cost of attaining the DPM degree must be addressed. The cost of tuition is outrageous across the board.

• Challenges are student loan debt with decreasing insurance payments, practicing podiatry where Ortho has been the predominant foot surgery specialty

• Would like advice on how to approach hospitals about becoming employed podiatrist within the organization

• As an active member in APMA on two committees and not on the YP committee, APMA doesn't have a good reputation with young physicians especially those coming from high surgical residency programs, not all but the vast majority. APMA needs to be able to separate itself from the appearance of bias and "selling", especially in the scientific meetings. Its brand is as the "union" or political force, the advocate for podiatrists, but APMA has spread itself too thin by feeding off of "special interest.” APMA is losing ground and its brand as an advocate to another swindler that wants podiatrists to just buy and pay for products its friends are putting out. Integrity needs to return to APMA and focus as an advocate and not a hawker of products for sale (aka the National)


• Available fellowships for us • I have concerns over ICD-10 and complications in proper coding in regards to

future reimbursements. Length of time in years until student debt is paid off. Nothing new or particular to just me; I think everyone is concerned about these to some extent.

• Student Debt is KILLING ME! • Achieving an adequate salary comparable to other physicians at the same stage • I have a strong distaste for our profession right now. Why is it that we still have states

where Podiatry can't do ankle surgery when every residency program is RRA? The job search process is quite a headache. There are numerous Podiatrists who say they are "hiring" but they actually don't have a job in their practice, and they offer a salary that is what we make as a resident or less; and they just want to take the money that we make anyways. Many never call you back, why place an ad in the first place? There are also a lot of podiatrists who are hiring who are just looking to take advantage of a young associate and don't realize we have over $200,000 in loans. We are all highly trained in reconstructive surgery now. I would rather work for an orthopedic group or a hospital than a Podiatrist who will take advantage of me.

• There needs to be a better system for helping residents find employment. Numerous wasted hours are spent scouring the Internet for jobs


• The residency shortage has always been a concern to me. It was not until I graduated from residency that I realized the greater problem is lack of quality employment. It does no good if you have a great medical education and residency if you cannot find a job. This is a wide spread problem and not unique to my local area.

• Many YP are taken advantage of in the real world by those that are supposed to be mentors/ leaders in the field; as a result there is a general distrust that has developed. APMA seems to cater to the older generation and seems out of touch. There are no national PR campaigns that have generated a foot health month like breast cancer awareness, or ADA ads to promote our profession. Membership costs are a big financial burden when your student loans come in at close to 2k a month and Malpractice comes in at close to 3-4K a month. After you pay all this there's hardly any money left for all the board fees & association fees.

• Improve job listing/promote other physicians to take on new practitioners. Suggest starting salary and contract conditions to other practitioners. Suggest business plan how taking in a new practitioner can beneficial to both parties.

• Give guidelines on how new practitioners could get on to various commercial insurance plans. Give steps and perhaps provide business plan to starting one’s own practice."


• Finding employment without a residency. We need more residencies so there aren't any unmatched graduates. It is incredibly difficult to find even low-paying non-podiatry work because I am so over-qualified. I want to work in podiatry and it is unacceptable that I do not have that option because of this shortage.

• More clear understanding of the basics in compliance and regulations. We are overwhelmed by specifics of DME, PQRS, meaningful use, clearing houses, DMEMAC, DMEPOS, etc. Many new physicians don't even know what these things are. Need basic course on compliance and regulations. We are overwhelmed by specifics of DME, PQRS, meaningful use, clearing houses, DMEMAC, DMEPOS, etc. Many new physicians don't even know what these things are.

• I want more information about military scholarship opportunities as a resident. • The ABFAS process change to CBPS vs. Oral.


2014 APMA Young Physician Survey Survey Fall 2014 BOT.pdf · 2014-11-20 · 2014. 2013. 2012. 2011....

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