Is an extra year of residency (4 years total) worth it for RRA?

[deleted1054119]

I guess this would be directed towards Attendings only but fellow residents are welcome to fill in with anecdotes:

I am a PGY1 at a small PMSR only program in the south. I have been offered an entry level RRA spot at a different program. Speaking solely from a financial standpoint would it be worth it to spend another 3 years in residency for rearfoot or should I push through with my last 2 years for PMSR?

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[josebiwasabi]

Plenty of people do well financially without doing anything RRA-related in practice.

What do you want to do with your career, and did you think the skill set of the graduating PGY3 class was one that you would be content with professionally?

 

[JewOnThis]

Yes, take the rra

 

[GreenHousePub]

Might as well change to it. You may be limiting yourself for no reason. I wasn't going to take the RRA abfas exam until an attending told me "why limit yourself." Ended up getting board certified in it now.

 

[Dochopeful13]

Yes, take the rra

Is there a big pay difference between someone RRA certified and not?

 

[CutsWithFury]

Is there a big pay difference between someone RRA certified and not?

Pay difference would be the number of cases you won’t be able to perform because you don’t have the RRA credential on your degree when applying for hospital privileges


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[Startingover123]

Might as well change to it. You may be limiting yourself for no reason. I wasn't going to take the RRA abfas exam until an attending told me "why limit yourself." Ended up getting board certified in it now.

Could you PM me. I have a few questions. Thanks!

 

[DYK343]

Better training is not extra. Take the RRA.

 

[heybrother]

RRA unfortunately doesn't necessarily guarantee quality.

Here's my big thing on training. We are supposed to be setting ourselves up for a lifetime of learning, improvement and experience. The problem in this profession is there is always someone ahead of you holding you down or stabbing you in the back. You lack the letters and someone else down the road will be able to block your path and your privileges. And it won't necessarily be an orthopod. Won't matter if you complete industry labs, scrub with other doctors, talk through cases, work with residents, seek growth to learn something you weren't trained in during residency - you skip the RRA you lose the certification path forever and in a lot of places you lose surgical priviledges and it doesn't seem like there's a remediation pathway to get them back. Essentially, you start off your career by limiting yourself and your growth. Its 3 years now, but its 30 years of your career later.

Do you need to be able to do those things to have a successful career? Depends upon what you want to do. Perhaps you will want to be the guy who tackles big cases or solves the problems that no one else can solve. There are a lot of pods who have zero interest (or training) in rearfoot. It is possible you'll do your training and still want to pass on these opportunities.

I'm personally skeptical you're missing out on that much revenue.

Where I really think you will be missing out is understanding the foot. We've literally take one of the smallest body parts and tried to divide it into the most delineations and its entirely artificial. Its all one darn thing. Its all interconnected. Its how you end up with hammertoe docs having no understanding or concept of equinus. Its how you get people with metatarsus adductus and wonder why your Austin failed even worse than normal. It produces doctors who only have a limited tunnel vision hammer and see everything as a nail. You don't even necessarily have to be able to fix everything - you just need to be able to recognize the bad stuff when it shows up so you know when to refer or know how bad things are or that you are over your head. Put yourself in a position where you can say - your problem is complicated. This isn't your friends foot that they got to walk on right away.

My personal thing - I always wonder about the doctors who have to spend their entire career trying to explain their surgical fails. Essentially the Austin guys who show up at the first post-op visit and the patient says - doc the bunion is still there. No, no, its great. Uh, we need to tape it a little more. Uh. You must have walked on it. Oh, well shoot, I guess we'll have to go back in and do an Akin. Don't worry - it'll be perfect.

Small rant, but so much of the training is just wrong and pointless. Get the best most diverse training you can get.

 

[GreenHousePub]

RRA unfortunately doesn't necessarily guarantee quality.

I also strongly suspect the sole PMSR programs are lacking in surgical numbers to even get the Foot surgery designation.

 

[heybrother]

I also strongly suspect the sole PMSR programs are lacking in surgical numbers to even get the Foot surgery designation.

I actually deleted some text wondering if this was an unfilled NYC RRA but then I thought - there are no well regarded PMSR so what does it matter.

 

[dtrack22]

I guess this would be directed towards Attendings only but fellow residents are welcome to fill in with anecdotes:

I am a PGY1 at a small PMSR only program in the south. I have been offered an entry level RRA spot at a different program. Speaking solely from a financial standpoint would it be worth it to spend another 3 years in residency for rearfoot or should I push through with my last 2 years for PMSR?

Would you be ok with the possibility of never being able to treat an ankle fracture, do any "ankle procedures," surgically treat achilles pathology? If the answer is "I might want to do that stuff at some point" then you should switch programs. If you can confidently say, "I will never care if my scope is further limited to surgical treatments distal to the ankle," then you don't need to go anywhere.

The RRA designation only prevents you from getting RRA certified by the ABFAS. That may limit your scope in some states (Oregon) or at certain facilities. However, you could end up practicing in a location where it doesn't limit anything that you treat surgically. Not getting training with the RRA designation is simply a gamble on being able to do certain surgical procedures in the future. It will not affect your income potential and doesn't change what you can see in clinic. It has the potential to limit you, but such limitations are not guaranteed.

Personally, as others have mentioned, I would switch for the simple fact that the training at your current program is likely garbage. No offense. If you can get significantly better training somewhere else, I would, even if it means one more year of indentured servitude. Though if you go work for another podiatrist after residency you'll have a few more years of that any ways...

 

[PTPuser]

Sorry to hijack OP's thread but I don't think this quick question needs a new thread. What about those programs that are 4 full years such as those at Penn? Is something like that worth it?

 

[dtrack22]

Sorry to hijack OP's thread but I don't think this quick question needs a new thread. What about those programs that are 4 full years such as those at Penn? Is something like that worth it?

Absolutely not. There is not a single argument to be made for doing a 4 year residency, outside of "my choices are doing 4 years at Penn or 3 years at DVA Atlanta..."

 

[perforating_peroneal]

Agree 100%

you’re better off doing 3 years and a fellowship (if needed)

 

[heybrother]

A review of Penn Presby's website essentially suggests to me that they slam you with off-service rotations. I see 3 months of vascular, 3 months of plastics, apparently a 1st year heavy in offservice medicine rotations. Having a strong surgical/medical background to recognize when things are going astray is a wonderful thing, BUT - your smart friends going to high quality programs are going to accomplish this in 3 years. There are no shortage of good programs that get the job done in 3.

In the end - we are all going to be podiatrists. None of us are going to manage insulin. 3 months of vascular will not make you a vascular surgeon - you will not do BKAs or bypasses when you graduate.

I did 1 month of vascular. Scrubbed a bunch of cases. They referred 99% of foot amputations to us so I didn't do a single foot on vascular. I enjoyed the cases, but I derived far greater value from (1) attendance in vascular wound clinic on rotation and intermittently off (2) open communication / co-managing patients with vascular throughout all 3 years. 1st phone number I was given in residency was the vascular surgeon's number. I read all their notes, rounded with them when I could. Reviewed all imagery/duplex/etc. If vascular told me they were going to round I went and rounded with them. Could 2 more months have been beneficial? Sure. I'd certainly prefer it to the 2 months of IM, 1 month of ID, and 2 weeks of CC I did, but at some point enough is enough for off service.

You could argue - what if there was a program that was just so amazing - where every year was great and valuable and so many good cases. But if that program is so great - shouldn't it just be an amazing 3 year program?

Last I checked there are ...3 four year programs. More could be coming.
-Penn
-Denver VA and the 4th year is optional and is like a wound care fellowship.
-Some program in Queens.

If you have to do a 4th year it should probably be a fellowship so you can forever say - I AM A FELLOWSHIP TRAINED FOOT AND ANKLE SURGEON. WHAT IS THIS poo-diaarhea-tree THAT YOU SPEAK OF? You'd also hopefully be somewhere with different, new ideas/thoughts/techniques etc.

 

[AttackNME]

I guess this would be directed towards Attendings only but fellow residents are welcome to fill in with anecdotes:

I am a PGY1 at a small PMSR only program in the south. I have been offered an entry level RRA spot at a different program. Speaking solely from a financial standpoint would it be worth it to spend another 3 years in residency for rearfoot or should I push through with my last 2 years for PMSR?

If you're hungry and having a broader scope of practice is important to you, then you should think about it, if you want bread and butter podiatry and don't want to do another year due to family or financial obligations then nothing wrong with staying.

Sorry to hijack OP's thread but I don't think this quick question needs a new thread. What about those programs that are 4 full years such as those at Penn? Is something like that worth it?

Having Penn or Temple (another 4 yr program) in your resume isn't a bad thing, it can help open doors. Also big programs with lots of residents will give you more connections with alumni of those programs. With that said I personally didn't look for 4 year programs thinking that it's that much better than 3 year programs.

 

[DexterMorganSK]

Last I checked there are ...3 four year programs. More could be coming.
-Penn
-Denver VA and the 4th year is optional and is like a wound care fellowship.
-Some program in Queens.

4-year programs, as of now:

NYP-Queens, NY
Mount Sinai, NY
St. Barnabas, NY
Temple Uni Hospital, PA
Penn Presbyterian, PA

 

[msion]

I would say 3 years of residency and 1 year of some podiatry job beats any fellowship training.
Just watch, as we get more and more fellowship-trained colleagues, someone will put that in the hospital bylaw as a requirement for other podiatrists to get privileges.
It's already happening with the ankle scopes. I don't think Orthopods know or care about a course certificate from ACFAS or IFAF. So wait, who put those in? Gotta be another colleague of ours.

 

[CutsWithFury]

I would say 3 years of residency and 1 year of some podiatry job beats any fellowship training.
Just watch, as we get more and more fellowship-trained colleagues, someone will put that in the hospital bylaw as a requirement for other podiatrists to get privileges.
It's already happening with the ankle scopes. I don't think Orthopods know or care about a course certificate from ACFAS or IFAF. So wait, who put those in? Gotta be another colleague of ours.

What states are saying you have to be “fellowship” trained to do ankle work?


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[uberconfuzzled]

Do the RRA. Don't limit yourself. Podiatry has changed a lot even in the last decade and it will continue to do so. The more you pigeon hole yourself, the less competitive and appealing you will be when it comes to finding a job. More importantly, doing an RRA gives you some exposure and experience to being a well rounded doc. Like others have said, the ankle bone is connected to the foot bone.

 

[dtrack22]

Podiatry has changed a lot even in the last decade and it will continue to do so.

don’t worry, you’ll be grandfathered in to any advances in scope or procedures, regardless of ability or training, just like every other podiatrist has been...

 

[msion]

What states are saying you have to be “fellowship” trained to do ankle work?


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I meant ankle arthroscopies.

 

[GreenHousePub]

Podiatry has changed a lot even in the last decade and it will continue to do so.

has it really though?

 

[uberconfuzzled]

has it really though?

In the sense of pods eating their young....no. That’s never gonna change

But overall I think the profession is changing. When I was starting pod school(about 10 +years ago) all of the teachers were the old guys who only did forefoot and chip n clip. Maybe we’d get a guest lecturer who had taught himself how to do an ankle or latched on to a orthopod at some point in his career to learn how to do a TAR (I’m sure those guys have retired by now-they were old as dirt). In residency, we had a few fresh attendings who just finished a fancy acfas fellowship. By now a majority of grads are least exposed to foot and ankle in their training. At some point the schools and residencies are gonna need new teachers and hopefully it won’t be the old chip n clip guys. You don’t see that as change? Or maybe I’m looking at it wrong.

Food for thought: I see the profession as starting to diverge into two main groups: wound care and surgery (both FF/RRA). Not a forefoot podiatrist vs rearfoot podiatrist, but strictly wounds vs bunions/ankles . At least this is the trend where I work at.

 

[Sartorius P.O.D.]

A review of Penn Presby's website essentially suggests to me that they slam you with off-service rotations. I see 3 months of vascular, 3 months of plastics, apparently a 1st year heavy in offservice medicine rotations. Having a strong surgical/medical background to recognize when things are going astray is a wonderful thing, BUT - your smart friends going to high quality programs are going to accomplish this in 3 years. There are no shortage of good programs that get the job done in 3.

In the end - we are all going to be podiatrists. None of us are going to manage insulin. 3 months of vascular will not make you a vascular surgeon - you will not do BKAs or bypasses when you graduate.

I did 1 month of vascular. Scrubbed a bunch of cases. They referred 99% of foot amputations to us so I didn't do a single foot on vascular. I enjoyed the cases, but I derived far greater value from (1) attendance in vascular wound clinic on rotation and intermittently off (2) open communication / co-managing patients with vascular throughout all 3 years. 1st phone number I was given in residency was the vascular surgeon's number. I read all their notes, rounded with them when I could. Reviewed all imagery/duplex/etc. If vascular told me they were going to round I went and rounded with them. Could 2 more months have been beneficial? Sure. I'd certainly prefer it to the 2 months of IM, 1 month of ID, and 2 weeks of CC I did, but at some point enough is enough for off service.

You could argue - what if there was a program that was just so amazing - where every year was great and valuable and so many good cases. But if that program is so great - shouldn't it just be an amazing 3 year program?

Last I checked there are ...3 four year programs. More could be coming.
-Penn
-Denver VA and the 4th year is optional and is like a wound care fellowship.
-Some program in Queens.

If you have to do a 4th year it should probably be a fellowship so you can forever say - I AM A FELLOWSHIP TRAINED FOOT AND ANKLE SURGEON. WHAT IS THIS poo-diaarhea-tree THAT YOU SPEAK OF? You'd also hopefully be somewhere with different, new ideas/thoughts/techniques etc.

Pretty much dead on about Penn. Can't speak of others. worst part is a lot of residents from there still do fellowships. 5 years of training, you move to Charleston, and still get denied ankle privileges because the letters after your name didn't change.

 

[heybrother]

Pretty much dead on about Penn. Can't speak of others. worst part is a lot of residents from there still do fellowships. 5 years of training, you move to Charleston, and still get denied ankle privileges because the letters after your name didn't change.

Take a look at the unfilled spots this year and you'll see that the 3 NY programs above offered 10 4-year spots and filled 3 of them. St. Barnabas filled 0 of its PMSR spots last update. I just don't understand why people wouldn't choose such an amazing opportunity!

 

[CutsWithFury]

Pretty much dead on about Penn. Can't speak of others. worst part is a lot of residents from there still do fellowships. 5 years of training, you move to Charleston, and still get denied ankle privileges because the letters after your name didn't change.

that's going to sting