ABFAS RRA

[deleted1162946]

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I passed all of my abfas exams except RRA cases. My current job doesn’t need RRA, and I plan on getting ABPM certified. I’m forefoot abfas qualified. Is there any reason to pursue RRA qualification in September and take the case exam? At my current job I will not be doing much rearfoot/ankle anyways

 

[Hybrocure]

I passed all of my abfas exams except RRA cases. My current job doesn’t need RRA, and I plan on getting ABPM certified. I’m forefoot abfas qualified. Is there any reason to pursue RRA qualification in September and take the case exam? At my current job I will not be doing much rearfoot/ankle anyways

I’m in your situation. Been a few years in practice ABFAS forefoot qualified without RRA at multiple hospitals in a large metro. Big numbers in RRA in residency but failed the rearfoot qual.

I don’t plan on doing RRA. In private practice I do not have the case load to meet that demand for cert. Few ideal patients come into my practice as ideal RRA candidates. I’d be morally butchering them if I planned on doing recons and such with the fairly asymptomatic generally mild rearfoot patients I see that could have a majority of their symptoms managed well if they use orthotics, wear good shoes, lose weight, or accept the fact they’re not going to be running marathons at 80 years old. I don’t get ankle trauma coming into my office or really any trauma beyond a jones fx.

That being said even with foot qual the hospitals still let me operate on the ankle if I wished to, but that has more to do with my residency logs than the ABFAS qualification. At this point it’s better for the patient if I refer to someone who does and wants to do those cases and does them regularly, and it’s better for my peace of mind

 

[deleted1162946]

this profession is really frustrating at times because everything is a money grab and there is no consensus on what to do.

Getting ABPM certified seems for sure a good idea. As you can go ahead and get certified in something.
Getting abfas foot certified does as well for the surgery centers/hospitals that want abfas.

If I don’t do rearfoot/ankle though why waste time on getting qualified in it when I won’t even have case volume to get certified (at current job). The only pro I see here is if I change jobs and RRA qualification is required or something. As you mentioned abfas foot at most hospitals gives you the ankle privileging.

 

[Hybrocure]

this profession is really frustrating at times because everything is a money grab and there is no consensus on what to do.

Getting ABPM certified seems for sure a good idea. As you can go ahead and get certified in something.
Getting abfas foot certified does as well for the surgery centers/hospitals that want abfas.

If I don’t do rearfoot/ankle though why waste time on getting qualified in it when I won’t even have case volume to get certified (at current job). The only pro I see here is if I change jobs and RRA qualification is required or something. As you mentioned abfas foot at most hospitals gives you the ankle privileging.

Don’t think about it too hard in the grand scheme of things.

If you’re not doing certain surgeries in an acceptable volume year after year you probably shouldn’t be doing them. It’s better for the patient and better for you. That’s why these hospitals ask for case logs year after year.

If I want my ankle fused I don’t want some guy doing it who hasn’t done one in 5 years but tells me “he’s done them before”. Even if he’s certified to do so by ABFAS.


This isn’t a problem exclusive to podiatry either. There are orthos on call who don’t do certain extremities and refer out because they specialize in spine or hip, or vascular docs who refer out because they specialize in carotids, abdominal, fistulas, instead of LE salvage.

Our profession is built of people who are inherently insecure. Nothing wrong with saying you can’t or won’t do something and passing it down the line. Lord knows there’s tons of other guys in town willing to take on your trainwrecks.

 

[HardRoadPaved]

Honestly I'm glad kicking this case bc an ankle fusion pays a whopping $750 in my area. I'm ok seeing a full day at clinic and sleeping in my bed at night.

 

[Bored Snorlax]

Do you need to pass all 4 ABFAS exams to be ABFAS certified?

 

[deleted1162946]

Do you need to pass all 4 ABFAS exams to be ABFAS certified?

No it’s separated between abfas foot and abfas RRA/ankle

 

[Feli]

CutsWith used to say it all the time, but you don't want to disqual yourself from any jobs/opportunities.
Don't give facilities any reason to limit you or other applicants/peers an easy way to be superior to you for jobs/raises/etc. Just because you can get by at your current job with X or you are ok with Y for now, that doesn't mean you'll want to work there forever. Even for the ppl who found a rural place that barely understands ABFAS/ABPM, there is no saying they'll make that sleepy podunk town their "forever home." Even if you did, there is no saying local hospital rules/regs couldn't change. Board qual expires.

When you've passed the didactic, passing RRA CBPS is basically just doing the BoardWizards a few more times. It's not like you are light years away. It gets much harder further out of residency (both memory and making time to study), so I would say definitely do it this year. A lot can change with your career and job options over the next 7 years.

Foot surgery ABFAS cert (or on track for it) is basically an essential to be considered for most decent pod org jobs - and even a baseline for most good PP jobs.
The RRA is a way to set yourself apart and is a req for a smaller percentage of podiatrist jobs.
They're both a good way to defend against getting your privileges limited/denied.

...Even in my own case (solo office, will never apply for jobs again), RRA cert is still on the radar.
I passed all of the ABFAS quals without issue, but it's fairly significant time evening/weekend to chase down the docu and screenshot XRs and make calls to get scans needed for board cert RRA application. That is lost time from $eeing pts or from my personal time, but I will probably still do it at some point. It's just good to be cred in what you do, and I do offer those services. If they pull old cases or I fail for whatever reason, I might give up on it.

Now, if I were still in the game of applying for hospital, group, etc jobs, then I'd say adding RRA would be a HUGE boon for that and a no-brainer that'd be absolutely worth making time for. The only people working employed jobs who shouldn't try for ABFAS are those who can't pass after a few good legit tries. Let's not forget there are 600 or so grads coming out every year now... some fellowship, many will try for RRA. Why limit yourself?

 

[Feli]

Honestly I'm glad kicking this case bc an ankle fusion pays a whopping $750 in my area. I'm ok seeing a full day at clinic and sleeping in my bed at night.

I feel same... but depending on practice area, there is not always a decent place to kick it to.

 

[Hybrocure]

CutsWith used to say it all the time, but you don't want to disqual yourself from any jobs/opportunities.
Don't give facilities any reason to limit you or other applicants/peers an easy way to be superior to you for jobs/raises/etc. Just because you can get by at your current job with X or you are ok with Y for now, that doesn't mean you'll want to work there forever. Even for the ppl who found a rural place that barely understands ABFAS/ABPM, there is no saying they'll make that sleepy podunk town their "forever home." Even if you did, there is no saying local hospital rules/regs couldn't change. Board qual expires.

When you've passed the didactic, passing RRA CBPS is basically just doing the BoardWizards a few more times. It's not like you are light years away. It gets much harder further out of residency (both memory and making time to study), so I would say definitely do it this year. A lot can change with your career and job options over the next 7 years.

Foot surgery ABFAS cert (or on track for it) is basically an essential to be considered for most decent pod org jobs - and even a baseline for most good PP jobs.
The RRA is a way to set yourself apart and is a req for a smaller percentage of podiatrist jobs.
They're both a good way to defend against getting your privileges limited/denied.

...Even in my own case (solo office, will never apply for jobs again), RRA cert is still on the radar.
I passed all of the ABFAS quals without issue, but it's fairly significant time evening/weekend to chase down the docu and screenshot XRs and make calls to get scans needed for board cert RRA application. That is lost time from $eeing pts or from my personal time, but I will probably still do it at some point. It's just good to be cred in what you do, and I do offer those services. If they pull old cases or I fail for whatever reason, I might give up on it.

Now, if I were still in the game of applying for hospital, group, etc jobs, then I'd say adding RRA would be a HUGE boon for that and a no-brainer that'd be absolutely worth making time for. The only people working employed jobs who shouldn't try for ABFAS are those who can't pass after a few good legit tries. Let's not forget there are 600 or so grads coming out every year now... some fellowship, many will try for RRA. Why limit yourself?

Going to play devils advocate here. What’s the point of being RRA qualified if you don’t feel comfortable doing RRA cases? If you end up at a job that expects you to make use of that you’re in for a world of hell

 

[Feli]

Going to play devils advocate here. What’s the point of being RRA qualified if you don’t feel comfortable doing RRA cases? If you end up at a job that expects you to make use of that you’re in for a world of hell

I agree in that case.
He never said anything about that... just that he doesn't see much RRA at current job (so training collects dust.. very common theme for DPM jobs).
I think I changed jobs 4 times in my first 7 years out, so the point is to keep your options open. I changed more than most, but the majority of my class and DPM stats overall say the first employed job is very seldom the last. Some of my jobs had very little RRA, some had quite a bit more.

Podiatry's very saturated, and to get ROI, you want to offer as many services and have as many check marks as possible on the CV. Most of the members here with higher pay org jobs do have RRA or are on their way. If trained for RRA, it makes sense to at least get qual for that. If you don't have training/desire to ever do RRA (and you're triple sure of that), then yeah, makes no sense. Remember that even ankle scope, Achilles, basic fibula fx, Brostrom, etc are RRA. Most DPMs with 3yr training do that stuff and want those privileges, and a lot of jobs (even many VA and PP jobs, etc) expect those skills and may pay more for them vs minimal/non op pod.

 

[diabeticfootdr]

this profession is really frustrating at times because everything is a money grab and there is no consensus on what to do.

Getting ABPM certified seems for sure a good idea. As you can go ahead and get certified in something.
Getting abfas foot certified does as well for the surgery centers/hospitals that want abfas.

If I don’t do rearfoot/ankle though why waste time on getting qualified in it when I won’t even have case volume to get certified (at current job). The only pro I see here is if I change jobs and RRA qualification is required or something. As you mentioned abfas foot at most hospitals gives you the ankle privileging.

You don’t need RRA to do foot and ankle surgery, it’s a myth. Lots of ABPM Diplomates have full surgical privileges based on their certification and education, training, and experience. We also fight for those who don’t get full privileges because of BC discrimination. Successful nearly all the time.

Apply for the privileges you feel comfortable with. Send me an email if you run into problems and send your Medical Staff Bylaws and DOPs.

 

[air bud]

CutsWith used to say it all the time, but you don't want to disqual yourself from any jobs/opportunities.
Don't give facilities any reason to limit you or other applicants/peers an easy way to be superior to you for jobs/raises/etc. Just because you can get by at your current job with X or you are ok with Y for now, that doesn't mean you'll want to work there forever. Even for the ppl who found a rural place that barely understands ABFAS/ABPM, there is no saying they'll make that sleepy podunk town their "forever home." Even if you did, there is no saying local hospital rules/regs couldn't change. Board qual expires.

When you've passed the didactic, passing RRA CBPS is basically just doing the BoardWizards a few more times. It's not like you are light years away. It gets much harder further out of residency (both memory and making time to study), so I would say definitely do it this year. A lot can change with your career and job options over the next 7 years.

Foot surgery ABFAS cert (or on track for it) is basically an essential to be considered for most decent pod org jobs - and even a baseline for most good PP jobs.
The RRA is a way to set yourself apart and is a req for a smaller percentage of podiatrist jobs.
They're both a good way to defend against getting your privileges limited/denied.

...Even in my own case (solo office, will never apply for jobs again), RRA cert is still on the radar.
I passed all of the ABFAS quals without issue, but it's fairly significant time evening/weekend to chase down the docu and screenshot XRs and make calls to get scans needed for board cert RRA application. That is lost time from $eeing pts or from my personal time, but I will probably still do it at some point. It's just good to be cred in what you do, and I do offer those services. If they pull old cases or I fail for whatever reason, I might give up on it.

Now, if I were still in the game of applying for hospital, group, etc jobs, then I'd say adding RRA would be a HUGE boon for that and a no-brainer that'd be absolutely worth making time for. The only people working employed jobs who shouldn't try for ABFAS are those who can't pass after a few good legit tries. Let's not forget there are 600 or so grads coming out every year now... some fellowship, many will try for RRA. Why limit yourself?

Long live Cuts

 

[Feli]

You don’t need RRA to do foot and ankle surgery, it’s a myth. Lots of ABPM Diplomates have full surgical privileges based on their certification and education, training, and experience. We also fight for those who don’t get full privileges because of BC discrimination. Successful nearly all the time.

Apply for the privileges you feel comfortable with. Send me an email if you run into problems and send your Medical Staff Bylaws and DOPs.

How do you get privileges if you don't get considered for the jobs?
Minor pesky details.

We get it that you can threaten to sue facilities, but you can't help people whose job app CV is tossed out from consideration for the position.
Again, why limit yourself?

 

[heybrother]

Not passing a test isn't a reason not to do something. That said - most people will not certify RRA. Its clearly visible in the data. In a more perfect world, people would self select better and not bother taking RRA if they aren't a good fit for it. ABFAS would lose a small fortune if this was to happen. There is literally a tiny cohort seeing RRA all the way through to certification but a line of people signing up to give them thousands of dollars to take the tests. You will know very quickly whether you are meant to be RRA or not. If in 2 years you are sitting there with a line of well aligned and healed ankle fractures and fusions and what not in your portfolio - well done. If you're doing 2 rearfoot cases a year - let it go. And if you are going to do foot - do it asap. There is nothing worse than being 5 years and hundreds of cases in and deciding to start logging. Just submit the cases the second you have them. Alternatively, do ABPM and if everything works out you can smile that you never had to go throught he stress of logging your cases or submitting to ABFAS dbags.

 

[deleted285117]

How do you get privileges if you don't get considered for the jobs?
Minor pesky details.

We get it that you can threaten to sue facilities, but you can't help people whose job app CV is tossed out from consideration for the position.
Again, why limit yourself?

One of those times where I 100% agree with both Lee and Feli.

… we need one Board.

 

[deleted1162946]

… we need one Board.

amen

 

[Feli]

One of those times where I 100% agree with both Lee and Feli.

… we need one Board.

In most other professions, yes (ie, MD/DO where the training is standardized, heavy selection on the front end, and residency standardized).

In podiatry, it won't work.
Too many variances in student quality and especially huge in residency curriculum/quality/standards.
We have many programs that routinely pass ABFAS, and may of them have high rate of fail.
We have programs doing cases weekly that other programs don't do at all. They're not anywhere near standardized.

Ergo, podiatry has, and will continue to, have alternate board(s). So, any DPM is smart to play the game as it is... not as it might be (someday... maybe... ideally... possibly).

 

[deleted285117]

In most other professions, yes (ie, MD/DO where the training is standardized, heavy selection on the front end, and residency standardized).

In podiatry, it won't work.
Too many variances in student quality and especially huge in residency curriculum/quality/standards.
We have many programs that routinely pass ABFAS, and may of them have high rate of fail.
We have programs doing cases weekly that other programs don't do at all. They're not anywhere near standardized.

Ergo, podiatry has, and will continue to, have alternate board(s). So, any DPM is smart to play the game as it is... not as it might be (someday... maybe... ideally... possibly).

I guess start from the bottom up… standardize/improve school training (therefore graduating student’s quality), then residency training. We all may be 90 y/o by then but hey, then we can get that single Board 🙂

 

[wakaflocka88]

One of those times where I 100% agree with both Lee and Feli.

… we need one Board.

Or just eliminate all boards. Useless in podiatry and in general.

 

[air bud]

Or just eliminate all boards. Useless in podiatry and in general.

Quit trying to suck up to Dtrack

 

[wakaflocka88]

Quit trying to suck up to Dtrack

Too lazy to find the chill daddy meme

Boards do nothing to protect the public or the profession except their own pockets and their fancy retreats to Vancouver to discuss the future. You don’t need to go to Vancouver to have a meeting. All lies. ABFAS ACFAS ABPM. Eliminate all of them. All this one board social media talk is just brainwashing stuff for the current crop of students and boomers gullible to follow this cult.

I passed ABFAS foot/rra all first try CBPS and case review. Not disgruntled. Just playing the game to keep the hospitals appeased on paper. I pay my due and move on with life.

 

[air bud]

Too lazy to find the chill daddy meme

Boards do nothing to protect the public or the profession except their own pockets and their fancy retreats to Vancouver to discuss the future. You don’t need to go to Vancouver to have a meeting. All lies. ABFAS ACFAS ABPM. Eliminate all of them. All this one board social media talk is just brainwashing stuff for the current crop of students and boomers gullible to follow this cult.

I passed ABFAS foot/rra all first try CBPS and case review. Not disgruntled. Just playing the game to keep the hospitals appeased on paper. I pay my due and move on with life.

Right but how do I as a podiatrist assert my dominance when I do not employ other podiatrists? There has to be a way.

 

[Feli]

Right but how do I as a podiatrist assert my dominance when I do not employ other podiatrists? There has to be a way.

Wear recovery shoes and disposable surgery cap everywhere... like maybe you are about to get paged do a bigtime surgery add-on.

 

[deleted285117]

I pay my due and move on with life.

Same here. Trust me, I care more about the Star Wars Outlaws release next month than podiatry board politics 😎😎😎

 

[Forcewielder]

RRA certification is very niche. I'm RRA qualified but all the cases I've done so far don't even count towards the specific criteria needed. Like I've got quite a few towards numbers but none for the specific RRA categories. Surgeries like mass excision, TAL, haglunds, Brostrum, peroneal augmentation, etc... none have counted towards the specific category requirements. I'm assuming they want trauma or fusions. Oh well. No one knows or cares in my state

 

[bigpodguy]

You don’t need RRA to do foot and ankle surgery, it’s a myth. Lots of ABPM Diplomates have full surgical privileges based on their certification and education, training, and experience. We also fight for those who don’t get full privileges because of BC discrimination. Successful nearly all the time.

Apply for the privileges you feel comfortable with. Send me an email if you run into problems and send your Medical Staff Bylaws and DOPs.

Thank you!

 

[Feli]

RRA certification is very niche. ... I'm assuming they want trauma or fusions. ...

Yeah, they want stuff that shows up on XR... osteotomies, fusions, trauma, recon.
It's just like the Foot cert... they are never going to pull cases for tendon or ligament recons, amp, ankle scope, TAL or gastroc, plastics stuff, mass, etc. Those have nothing objective to criticize. I did a microfracture scope with ATFL+CFL rebuild this morning followed by tib ant neglected rupture lengthen/repair... no chance those ever get pulled for ABFAS. Those do count for numbers towards RRA cert, but for the cases review, they will pull all or nearly all stuff that has fixation.

...It goes back to how awesome it'd be if we have 10 or 20% of DPMs - so 2000 to 4000 - doing all of that stuff (highly trained and proficient and continually competent in RRA that way). Instead, we have most DPMs doing just a few legit osseous RRA recons per year (some doing more), doing mostly derm/nail/wound stuff, and getting very little ER refers or calls for RRA trauma. That is why RRA cert is so relatively rare... and in highest demand and pay scale for most podiatrist hospital jobs (best path to RRA cert typically). The way it is now, almost all of the approx 2k F&A orthos do more RRA in a month than 95% of DPMs do in a whole year (probably 98% honestly).

 

[Hybrocure]

Yeah, they want stuff that shows up on XR.
It's just like the Foot cert... they are never going to pull cases for tendon or ligament recons, amp, ankle scope, TAL or gastroc, plastics stuff, mass, etc.

so basically all the stuff the average pod does that involves RRA

 

[Forcewielder]

Yeah, they want stuff that shows up on XR... osteotomies, fusions, trauma, recon.
It's just like the Foot cert... they are never going to pull cases for tendon or ligament recons, amp, ankle scope, TAL or gastroc, plastics stuff, mass, etc. Those have nothing objective to criticize. I did a microfracture scope with ATFL+CFL rebuild this morning followed by tib ant neglected rupture lengthen/repair... no chance those ever get pulled for ABFAS. Those do count for numbers towards RRA cert, but for the cases review, they will pull all or nearly all stuff that has fixation.

...It goes back to how awesome it'd be if we have 10 or 20% of DPMs - so 2000 to 4000 - doing all of that stuff (highly trained and proficient and continually competent in RRA that way). Instead, we have most DPMs doing just a few legit osseous RRA recons per year (some doing more), doing mostly derm/nail/wound stuff, and getting very little ER refers or calls for RRA trauma. That is why RRA cert is so relatively rare... and in highest demand and pay scale for most podiatrist hospital jobs (best path to RRA cert typically). The way it is now, almost all of the approx 2k F&A orthos do more RRA in a month than 95% of DPMs do in a whole year (probably 98% honestly).

Honestly I hadn't thought about the xray aspect. Makes sense, but even in my residency we did the majority of our RRA as soft tissue or ankle fractures. The elective osseous was very lacking for us and I can't imagine there are many pods in a job setting where they get those very regularly. I personally see maybe 1 good candidate for rearfoot fusion every quarter. Most have too many comorbidities to justify. And all the trauma goes ortho. This is a weird profession.

 

[Feli]

...The elective osseous was very lacking for us and I can't imagine there are many pods in a job setting where they get those very regularly. ....

Yeah, but there are plenty of pods who 'create' those cases by just doing them to do them and/or doing them on questionable candidates. 🙁

 

[air bud]

RRA cert. So much flatfoot out there. Like legit flatfoot. Osteotomy vs arthrodesis. Make sure you do as many Evans MCDO in residency as you can. Clear way to separate.