1. science
2. medicine

WHO CAN JOIN?
Fellow status is available for doctors who are
board certified by the American Board of Podiatric Orthopedics & Primary Podiatric Medicine. Fellows are allowed to use the designation
“FACFAOM” after their DPM degree on business
stationery and promotional materials.
Associate status is available for doctors who have
passed the qualification examination of the American Board of Podiatric Orthopedics & Primary
Podiatric Medicine.
Member status is available for doctors who are
interested in increasing their clinical skills and enhancing their practices but who are not eligible to
be board certified by the American Board of Podiatric Orthopedics & Primary Podiatric Medicine.
Admission is based on a review of four clinical
cases submitted to the Membership Committee.
HOW TO JOIN
The simplest way
“If I could attend only one meetto join ACFAOM
ing each year to stay current as a
for any of the
clinician, the annual ACFAOM
five memberClinical Conference would be
ship categories is
it. It is a well planned, compreto download an
hensive podiatric meeting that
application form
informs, educates, and re-enforces
at www.acfaom.
all aspects of podiatric medicine.”
org and return it
–G. Javier Cavazos, DPM,
with your first year
FACFAOM (McAllen, Texas)
dues (either credit
card or check)
and any required documentation to the ACFAOM
office at:
American College of Foot & Ankle Orthopedics
& Medicine
Attn: New Member
5272 River Road, Suite 630• Bethesda, MD 20816
Resident membership is available to residents
enrolled in podiatric residency training programs
that have been granted candidate status or have
been approved by the Council on Podiatric Medical Education.
For more information about ACFAOM, including
current dues rates, please call (301) 718-6505 or
visit www.acfaom.org. We look forward to welcoming you as a member, and we appreciate your
interest in ACFAOM!
Student membership is available to students enrolled in colleges of podiatric medicine accredited
by the Council on Podiatric Medical Education.
or in a recognized, equivalent foreign program in
podiatry recognized by the Board of Directors.
Discover the benefits of
ACFAOM membership for
yourself.
All ACFAOM members must be members in
good standing of the American Podiatric Medical
Association.
For more information about a specific membership category or the membership process, call
(301) 718-6505 or visit www.acfaom.org.
JOIN TODAY
at www.acfaom.org!
•5272 River Road, Suite 630
Bethesda, MD 20816
•Tel: (301) 718-6505
•Fax: (301) 656-0989
•E-mail: [email protected]
•Web site: www.acfaom.org
“Being a member of ACFAOM has helped enrich my
practice in a competitive market in many ways. From
no-nonsense coding seminars, CMEs from the annual
scientific meeting, and the collegial atmosphere within
the college; ACFAOM membership is a great value.”
–Jason C. Harrill, DPM, FACFAOM
(Mesa, Arizona)
ENJOY THE BENEFITS OF
ACFAOM MEMBERSHIP
ACFAOM is the essential professional
society for success in the day-to-day
practice of podiatry.
ABOUT ACFAOM
Since the 1940s, the American College of Foot
& Ankle Orthopedics & Medicine has focused
its attention on both the clinical and economic
aspects of practicing podiatric medicine. As a
professional medical society representing the
bulk of podiatric practice, ACFAOM has led the
effort to assure that what most podiatrists do in
practice remains the basis of the full scope of
podiatric clinical care and has provided services
to help its members be better clinicians and successful practitioners.
AFAOM’s mission is to assure that primary podiatric medicine, broadly defined as orthopedics and
medicine of the lower extremities, is the cornerstone of contemporary podiatric practice.
HOW MEMBERS BENEFIT
Being a member of ACFAOM, a society created by doctors like you, helps you practice
podiatry better and more successfully by:
•
Issuing an impressive membership diploma that
will broadcast to your medical colleagues and
patients your special expertise
•
Holding an annual Clinical Conference oriented
to the newest clinical techniques and most current clinical evidence, and which combines the
related reimbursement concerns, so you can
incorporate the information and techniques into
your practice immediately
•
Providing a subscription to The Foot, a quarterly
international journal of podiatric orthopedics,
medicine, and biomechanics to keep you current
in your specialty
•
Presenting coding and billing seminars throughout the country to help assure that your practice
is fully reimbursed and workshops to help your
staff become certified podiatric coders
•
Providing opportunities to participate and hold
leadership positions in the College to enhance
your professional skills and reputation
•
Publishing a professional directory on the Web
site to allow the public and medical colleagues to
locate you easily
•
Advocating nationally on your behalf the importance of orthopedics and medicine as the
cornerstone of contemporary podiatric practice
•
Publishing the Review Text in Podiatric Orthopedics & Primary Podiatric Medicine, which you
will use time and again in your office.
•
Distributing ACFAOMGrams to immediately
inform you by blast email of any pressing issues
of interest or potential impact on your practice
•
Publishing the quarterly ACFAOM Newsletter,
packed with College and related news, quality
clinical and practice management articles, and
insightful interviews
•
•
Arranging for significant discounts on all publications by Elsevier, including the popular annual
Clinics in Podiatric Medicine and Surgery (4
issues a year)
Maintaining a user-friendly Website to inform
the public about the benefits of using our members for their foot and lower extremity problems
and with a “members only” section for special
membership issues
•
Offering “state-of-the-art” educational DVDs
to inform your patients and potential referral
sources about the wide range of lower extremity
problems that you treat.
•
Publishing the very useful Prescription Custom
Foot Orthoses Practice Guidelines bi-annually
“ACFAOM is working to assure that what I do in practice 80% of the time remains the basis of all of podiatric practice” – Tracy M. Reed, DPM, FACFAOM (St. Louis, Missouri)
TheAmerican College of
F OOT &A NKLE ORTHOPEDICS
& MEDICINE
APPLICATION FOR MEMBER STATUS 2009
Name: ________________________________________________________________________________________________
Position:________________________________________ Clinic/Practice Name: __________________________________
Office Street Address: __________________________________________________________________________________
City:___________________________________________ State:___________ Zip: ________________________________
Office Phone:__________________________________ Office Fax: ______________________________________________
E-mail:_______________________ Web Site:__________________ Gender: ❒ M or ❒ F
Date of Birth:____/____/____
(We do most membership correspondence via e-mail.
EDUCATION: List in chronological order all undergraduate, graduate, and professional schools attended, including podiatry college.
Name of School
City - State
Degree
Dates Attended
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
ELIGIBILITY: To be eligible for “Member” status in ACFAOM you cannot be board certified or eligible to be board certified by the
American Board of Podiatric Orthopedics & Primary Podiatric Medicine (ABPOPPM.) The appropriate membership status if you belong
in this category is "Fellow" of ACFAOM. To help us determine your eligibility for the "Member" status, please indicate below the type
of residency training and the years of residency training you experienced after receiving your DPM degree. If it is determined that you
are not eligible for "Member" status, you will be notified and given the option of applying for "Fellow" status or receiving a full refund
of the first year's annual dues paid with your application. Please indicate below your residency training:
Residency Type
(check all that apply)
❒
❒
❒
❒
Years
From
To
No residency training
RPR
__________
____________
POR
__________
____________
PPMR
__________
____________
__________
____________
❒ PSR-12
Residency Type
(check all that apply)
❒
❒
❒
❒
❒
Years
From
To
PSR-24
__________
____________
PSR-36
__________
____________
PM&S-24
__________
____________
PM&S-36
__________
____________
Other: Please explain
PROFESSIONAL: Are you a member in good standing of the APMA? ❒ Yes ❒ No APMA Member #_______________
Do you hold an active license to practice podiatric medicine? ❒ Yes ❒ No
State:_______ License #: ________________
ACFAOM members are listed in a database on our Web site, which is searchable by physicians and podiatrists for referrals and by
prospective patients seeking a podiatrist. I hereby ❒ agree ❒ do not agree to have my name listed in ACFAOM’s searchable database.
ACFAOM typically contacts members by e-mail to notify them of important issues, remind them of upcoming deadlines or provide
them information regarding new products or services. I ❒ do ❒ do not grant permission to ACFAOM to contact me by e-mail.
I certify that the information in this application is true and accurate.
Signature:_______________________________________________________ Date: ____________________________
(over)
Application for Member Status 2009
Page 2
ANNUAL DUES: Member $250.
❒
For members who meet the APMA definition of Faculty, Federal Service, Non-Practicing or first to fourth year Associate, please check here
if you qualify and deduct 30% from your annual dues.
ACFAOM dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as a business expense. Consult your
tax advisor.
Charge to my:
❒ Credit Card
❒ Check enclosed
❒ Amex
❒ MC
❒ VISA
Dollar Amount: $ ________________________________________
Name of Cardholder:______________________________ Signature: __________________________________________________
Card Number:____________________________________ Expiration Date: ____________________________________________
Submit this application form with credit card payment information by fax to 301.656.0989, Attention: Ms. Maurelus, Membership
Coordinator (Remember to fax both sides of this form).
Or mail to the following address:
American College of Foot & Ankle Orthopedics & Medicine
5272 River Road, Suite 630 • Bethesda, MD 20816
1.800.265.8263 • 301.718.6505 • Email: [email protected] • Website: www.acfaom.org
Process for Case Reviews
Once "Member" eligibility has been established, you will be notified and you will move to the next phase of admission. "Member"
status is based on a review of four (4) case records that you may select from your files. The four case records submitted should be
redacted (i.e., personal patient information blacked out) copies of the original case records. If hand written, all words must be legible.
You will be asked to select four (4) cases from your practice that demonstrate your clinical skills in one or more of the following
clinical areas: Orthopedics/Biomechanics; Medicine; Radiology; Dermatology; Pediatrics. Thus you may select one case in each of
four areas, up to all four cases in only one area, or a combination.
The case review process is supervised by the ACFAOM Membership Committee and is standardized to assure objectivity. Each case
report will be assessed and scored on the following aspects: Quality of Medical Records; Medical History & Physical Examination;
Ancillary Testing; Diagnosis & Management of Care; and Follow-up. The scoring system for each of these areas is based on a 5-point
scale: 1 (inadequate); 2 (substandard); 3 (standard); 4 (above standard); 5 (superior.). The overall score for each case will be the
average of the scores for each of the 5 areas, with 3.0 overall required for a passing score for each case. A passing score on 3 of the 4
cases submitted is required to be eligible for the "Member" category.
In the event that two or more of your cases score less than 3.0, they will be returned to you for further work and resubmission. If cases
are not resubmitted within 4 months, your application for "Member" status will be considered terminated and a refund of the dues paid
less a $50 administrative fee will be sent to you.
The preferred method of case record submission is electronically by email to [email protected], with one PDF attachment
(including lab results and radiology images) for each case. If you prefer to mail your cases, send them to Norman Wallis, PhD,
ACFAOM, 5272 River Road, Suite 630, Bethesda, MD 20816.
If you have any questions about this process, or need help, please contact Norman Wallis, PhD, Executive Director, at 301.718.6539 or
[email protected]. Do not submit cases until invited to do so when "Member" eligibility has been confirmed.
01/2009