So…About Those Boards

First a little background information because, oddly enough, the path to becoming a certified foot surgeon apparently is not common knowledge. To get to where I am today I had to go through undergrad followed by four years of podiatric medical school and a three year surgical residency. Like any other schooling, there were tests, midterms, and finals along the way. Unlike other schooling paths, there were also a whole slew of national board examinations to pass. These are the important ones, since failing any meant no licensing and therefore no work regardless of getting a diploma. My medical school diploma really grants me a whole lot of nothing except the ability to sit for more tests. Yay!

No new media because studying, so you get a complication of my favorites from the past year. This one takes the cake as the first time I enjoyed jumping Gemmie and was over the last fence in our first ever 2′ jumper course. 

Here are all the boards I have taken since 2006:

Part 1 NBPME (National Board of Podiatric Medicine Examination)/USMLE Equivalent (no clue what this stands for) Boards – didactic (multiple choice, academia based questions like any other standardized style test) examination. Taken after 2 years in medical school and based on the fundamentals: pharmacology, pathology, biochemistry, anatomy, physiology, and some other classes I no longer remember.

Part 2 NBPME- didactic examination taken at the end of the 4th year of medical school. Covers podiatry specific topics including medicine, surgery, biomechanics, physical therapy, sports medicine and on and on.

Part 3 NBPME- didactic examination which basically covers everything part 2 does only more surgical based. I was never sure why we had to take this, but I assume it is for money reasons. This is either taken right after 2 or after 1 year of residency depending on the state you do your residency in. Passing this part grants you your license to practice medicine and perform simple in office procedures (removing ingrown nails, warts, removing soft tissue masses and the like).

Gemmie and I tackling our first ever “ditch” at Windridge while out cross country schooling. PC Bette Mann. 

Thankfully, after passing all three of those, you no longer have to give your money to the NBPME. However, you still aren’t done giving away your money to take tests. While in residency, every single year you take the American Board of Foot and Ankle Surgery Training Exam. My residency paid for this each time which was a nice bonus and I took it a total of 3 times by the time I graduated. This is the important test series for my current story.

These exams are two parts. Part 1 is the run of the mill standardized didactic multiple choice test on all things surgery: peri-operative management, surgical principles, complications, post-operative care and a slew of other topics. Easy to study for as long as you don’t mind going through phone book sized texts, online practice exams and articles. Part 2 is a whole other beast. It is a computer simulation of patients. The exam gives a brief, and incredibly not helpful, presentation of the patient. From there you have 15 minutes to perform an exam (there is a drop down menu of items to select from such as “palpate the fifth toe” and “range of motion ankle joint”), order any pertinent labs and imaging studies, diagnose the patient, provide treatment, get a complication, diagnose the complication, and finally treat the complication. I could go on about the specifics of the test and how it sets everyone up for failure, but I won’t bore you all with that.

By the time you graduate from residency you will have taken this three times (in addition to the three boards taken to get to residency) and each time the test format is the same: three hours to do the didactic portion followed by three additional hours to take the computer based portion (CBPS). You kind of get into the groove of this test after the first couple of times.

Wyatt holding a better jumping position than I likely ever will

Then right before you graduate residency, typically in May, you take the American Board of Foot and Ankle Surgery Qualifying Foot Exam which is the exact same format as the training tests, only this time residency doesn’t pay for it (it costs over $2,000 for those who were curious) and passing this gives you the right to do foot surgery on your own after graduation. You can also, and I did, take the American Board of Foot and Ankle Surgery Qualifying Reconstructive Rearfoot and Ankle Exam, another two parter only focused solely on reconstruction of the rearfoot and ankle. The qualification lasts 7 years during which you perform surgery and collect cases until you have performed 65 foot cases and an additional 30 ankle cases if you decide to sit for those as well. While I passed both exams, in SC I am not permitted to do ankle work (a highly political discussion about scope of practice could occur here but I won’t), so while I am qualified in ankle surgery I wont ever be certified in it.

Ok..everyone caught up? To date I have taken 8 sets of boards with the last 5 all being two parts didactic and CBPS.

At the completion of my first ever CT last June. We ended up in 4th out of 9 with no jumping penalties over some very decorated jumps. 

This morning was my American Board of Foot and Ankle Surgery Certification Foot Exam . I had submitted all my cases way back in March and now was time for the computer part. Registration was last November and the cost was equivalent to prior tests (around $1,600 if I recall correctly). Come January I started studying, slowly ramping up through March when I hit the panic button, ceased all extra curricular activities including riding and spent every night for two hours from 8-10 pm studying before bed. I made note cards on topics that would not stick. I had a journal filled with notes from text books I poured over. I stressed. And stressed some more. I then found an online practice test bank, shelled out $250 for access, and proceeded to take nearly 3,000 questions over the course of 6 weeks.

I was focused. I was determined.

You can just imagine my reaction then when I sat down to take this test this morning and saw on the screen “Welcome to the CBPS exam”. I paused.

Then I panicked! I had signed up for only half the test! Where was the didactic portion?? I had spent close to 200 hours studying for it. What was going on? Can I take only half a test?? What was I doing???

My last jumper rounds with Gem back in February. I’m not sure I will never take her out and do a course again, but her main job will no longer be jumping. 

Having only 15 minutes per case, I set aside the panic and settled in for the torture that is the CBPS exam and three hours later I exited the exam center, grabbed my cell phone and immediately logged into my ABFAS account to see where on earth I screwed up.

Turns out there is no didactic portion to the certification exam. Unlike the prior 8 tests of the same name and under the same board of examiners which were all two part tests, this one was only the CBPS. You can’t study for the CBPS. It is impossible to. There are no academic questions. No anesthesia, classification systems, pharmacology etc…questions. Let me repeat this…YOU CAN NOT STUDY FOR THIS TEST.

The 200 hours, the lack of sleep, the no riding, the weekends spent reading and taking notes? USELESS. Utterly, devastatingly useless. 

I’m not really sure whether to laugh or cry to be honest. My days are pulled in so many directions at all times… mother, physician, boss, business owner, wife, farm work, hobby equestrian…that it is a wonder I get anything right. I know that if I did fail this time, when I go to retake it next year I won’t be making this mistake again and will instead cruise on up to the test hoping for the best.

I suppose it really doesn’t matter now anyway. It is over with. Friday I go pick up E if he passes the PPE and all next week I am on vacation. I took it off as a reward for all my hard studying. HA!!! Oh man. Don’t be me folks. Seriously, I can’t get over this incredible journey and the fact that it was 100% unnecessary and even worse, not helpful in the slightest. I would have performed the exact same without all that studying. It boggles my mind al the stressing I did for nothing. I guess it is better to over prepare than under, but man my life has been a self imposed suck fest for months!! It would have all been worth it to pass the test and settle in for 10 blissful years boards free, but for it all to amount to nothing? For it all to be for naught? Ugh. I think I may settle in tonight with my bottle of a friend’s homemade toasted marshmallow wine (delicious by the way) and try to forget this day ever happened.




I’m a Person too, You Know.

“I hate podiatrists. Go see an orthopedist”

A response to someone on Facebook looking for help with a foot injury. I only saw it because a friend of mine tagged me and recommended my services.

I could go on about the differences in the two specialists, but that isn’t what I want to focus on. In truth, there are benefits to going to either and there are times I tell my own patients that they would be better served by an orthopedist.

Here is what I do want to focus on: the blanket and negative statement toward an entire group of people who have dedicated their lives to curing you of your lower extremity ailments.

Being a doctor is a full time lifestyle. It’s not something you can turn off, pile up and walk away from until the next shift. There is no ability to forget your patients and carry on. I’m on call 24/7 and I have been contacted by patients at all hours of the day, on weekends and holidays. I worry about those who have trusted me with their care and I do take things personally.

So when I see someone so flippantly negating an entire profession, writing them off as if they are not real people with real emotions, it makes me angry.

Your physician is a person. I guarantee you they are not out to cause harm or create worsening of your condition. I can tell you that they care about your outcome. How would like it if I declared that I hate all teachers, plumbers, HR personnel? Pretty ridiculous, isn’t it? Yet people get away with hating on the medical profession all the time.

You get angry if you have to wait more than 10 minutes yet the very next time you call to get worked in and get angry when you are told there isn’t any available time to do so. You want the doctor to be at your beck and call and then wonder why they appear tired, stressed and burnt out.

I’m a person. A person who dedicated  11 years to the study of your body and how to fix what can go wrong. Someone who didn’t travel or save up money when I was younger instead going deeper in debt and killing my eyesight reading endless textbooks and taking test after test. A person who does her best each and every day but just like you I am a person who sometimes wakes up overly tired or cranky. Can you honestly tell me that you never went to work tired and barely scraped by all day?

Before you write off an entire body of people who would have been way smarter to choose another profession, but chose this one out of a passion for helping others, remember that we are people too. Our job isn’t just a job. It gets carried home with us, bleeds into our regular conversations and wakes us up at 2 am with thoughts on what we could do differently.

I am more than just a podiatrist. I am a person too.