APMA House of Delegates — 30 Years of Major Decisions

Era I · Foundation & Restructuring · 1996–2002

Legislative Advocacy

Medicare Coverage for Therapeutic Footwear

HOD directed APMA to pursue permanent Medicare coverage for therapeutic shoes for persons with diabetes (TSD), establishing a key reimbursement pillar that would protect DPM practices for decades.

Benefit: Protected diabetic foot care revenue across the profession and established DPMs as primary diabetes foot care providers.

Advocacy

1997

1999

Scope of Practice

Rearfoot / Ankle Surgery Recognition

HOD formally recognized reconstructive rearfoot and ankle surgery as within the scope of podiatric practice, a landmark step in expanding the profession's surgical mandate and laying the groundwork for PMSR/RRA residency tracks.

Established the professional basis for ankle surgery privileges — a battle still being fought at hospital credentialing committees today.

Scope

Governance

CPME Independence Reaffirmed

HOD addressed the governance relationship between APMA and the Council on Podiatric Medical Education (CPME), affirming CPME's authority to set accreditation and residency standards — a tension that would resurface repeatedly over the next 25 years.

Set the framework for the ongoing APMA-CPME jurisdictional debate over who controls residency and education standards.

Governance

2001

Era II · Residency Revolution · 2003–2009

2003

Training & Education

Unified Residency Program Framework Established

HOD and CPME overhauled the patchwork of 1–4 year residency types into a unified framework of PMSR (Podiatric Medicine and Surgery Residency) and PMSR/RRA programs. Programs now required a minimum of 2–3 years, depending on type.

The single most important structural reform in modern podiatric education. Replaced a fragmented system with a coherent, defensible training model.

Education

Governance · Vision Document

APMA Vision 2015 — First Call for One Board

HOD adopted the Vision 2015 strategic framework, which explicitly called for consolidation toward a single certifying board in podiatric medicine and surgery. This document became the foundational policy reference for the One Board movement for the next two decades.

Launched nearly 20 years of negotiation — and conflict — between ABFAS and ABPM, with APMA caught between them.

Governance

2005

2007

Legislative Advocacy

DEA Prescribing Authority Expansion

HOD directed APMA to advocate for full DEA prescribing authority for podiatric physicians in all states, pushing for uniform controlled substance prescribing rights consistent with the profession's training. Several states had historically restricted DPM prescribing privileges.

Enabled DPMs in remaining restricted states to prescribe opioids and controlled substances, normalizing clinical authority.

Advocacy

Scope of Practice

Hospital Privileges Anti-Discrimination Policy

HOD passed a resolution opposing the use of board certification as the sole criterion for hospital credentialing and privileges, directly challenging institutions that excluded DPMs from surgical service lines despite equivalent training.

Gave APMA the policy backbone to challenge discriminatory credentialing — a battle residents still face at hospital orientations today.

Scope

2009

Era III · Training Standardization · 2010–2017

2012

Training & Education

Mandate: All Residencies Minimum 3 Years

HOD directed CPME to require all podiatric residency programs to be a minimum of 36 months, phasing out 2-year programs. This mandate took full effect in 2013 and transformed the post-graduate landscape of the profession.

Since 2013, every graduating DPM has completed 3 years of training — the single most important parity advance vis-à-vis orthopedic residency.

Education

Legislative Advocacy

ACA Implementation — DPM Inclusion in ACOs

Following the Affordable Care Act, HOD directed APMA to advocate for full DPM inclusion in Accountable Care Organizations, bundled payment models, and integrated care delivery systems — fighting for inclusion at the table of healthcare reform.

Shaped APMA's decade-long push for DPMs to be recognized as primary foot care providers in value-based care frameworks.

Advocacy

2014

2016

Board Certification

JCRSB Reform — Certification Equivalency Standards

HOD directed APMA and the Joint Committee on Recognition of Specialty Boards (JCRSB) to establish clear and equivalent standards for board recognition, amid growing discontent over ABFAS and ABPM credential disparities and their real-world impact on hospital privileging.

Elevated the One Board debate to a formal governance track and acknowledged that two boards were creating professional inequity.

Certification

Era IV · Reform & Conflict · 2018–2022

Training & Education

BOT Recommends ACGME Milestones Model

The APMA Board of Trustees formally wrote to CPME's 320 Residency Ad Hoc Advisory Committee recommending a transition from Minimum Applicable Volume (MAV) case counting to the Milestones/Competency-based model adopted by ACGME in 2013. HOD supported this direction.

CPME ultimately deferred action on Milestones — creating a persistent tension that became the basis for the explosive 2025 propositions.

Education

2019

2020

Legislative Advocacy

COVID-19 Emergency Response & Telehealth Policy

Amid the pandemic, a virtual HOD passed emergency resolutions directing APMA to advocate for DPM inclusion in telehealth reimbursement, support for podiatric residents impacted by hospital access restrictions, and policy flexibility during the public health emergency.

Led to APMA securing telehealth reimbursement parity and established podiatric residency protections during unprecedented healthcare system disruptions.

Advocacy

Scope of Practice

Wound Care & Skin Substitute Coverage Defense

HOD directed APMA to mount sustained opposition to CMS's proposed restrictive Local Coverage Determinations (LCDs) for skin substitute products used in diabetic foot ulcer care — protecting a core DPM revenue stream and patient care pathway.

APMA secured temporary withdrawal of the most restrictive LCDs, preserving patient access and DPM wound care practice — a fight that continues to 2026.

Scope

2022

Era V · The One Board Reckoning · 2023–2026

2023

Training & Education

CPME 320 Revised — Milestones Deferred

CPME formally adopted revised CPME 320 standards (effective July 2023), the foundational residency document. However, the Council controversially deferred Appendix C (Milestones) — rejecting the ACGME-aligned competency model championed by APMA BOT since 2019, triggering significant professional backlash.

The deferral became the political flashpoint driving the major HOD reform propositions of 2025 and 2026.

Education

Board Certification · Major Vote

Proposition 2-24: One Board Policy Passes (62%)

Over 1,400 podiatrists signed the petition in support. HOD passed Proposition 2-24 with ~62% of the vote, making it official APMA policy to support formation of a single certifying board — and directing creation of a One Board Task Force. ABPM championed; ABFAS opposed.

The Task Force was later halted when legal counsel raised Sherman Anti-Trust Act concerns — leaving the One Board mandate as policy without a path to execution.

Certification

2024

2025

Governance · Education · Major Package

Propositions G–K-25: CPME Reform Slate

The most sweeping package of HOD propositions in recent memory addressed: CPME transparency and conflict-of-interest disclosure (G-25), CPT-based procedure logging replacing CPME case categories (J-25), ACGME parity language for residencies (J-25), ACGME parity for fellowships (K-25), and BOT veto authority over CPME draft standards (I-25).

Passed with significant support. Directed CPME to implement CPT logging by July 2026 and strive for ACGME parity — signaling HOD's growing willingness to override CPME's institutional resistance.

Governance

Scope of Practice

New York Scope of Practice Modernization

New York enacted a modernized scope of practice law championed by NYSPMA, aligning statutory authority with podiatric education and residency training. HOD directed APMA to use NY as a model to pursue comparable scope updates in remaining restrictive states.

A blueprint for nationwide scope modernization — each state that expands scope sets precedent and enables advocacy in others.

Scope

2025

2026

Governance · Certification · Present

Propositions U-26 & 7-26: CPME Oversight & Consolidation

The 2026 HOD under DeHeer's 100th-presidency milestone takes up U-26 (CPME governance restructuring and HOD oversight authority) and 7-26 (further board certification consolidation measures). The ABFAS-ABPM divide remains the defining political fault line of organized podiatry.

The outcomes of 2026 will determine whether the profession can finally execute on the One Board mandate of 2024 — or whether the antitrust impasse becomes permanent.

Governance