Another thread about ABFAS...

[JR77593]

Hey everyone. Having failed ABFAS after my first real attempt at it, had some questions.

1) Do I really need RRA or is Foot alone enough? RRA is really focused on TAR, complex recon, supramalleolar/tibial/fibular osteotomies that I really did not have much exposure to in residency and/or things that I have no desire of doing when I'm out. I'd like to save half of the exam cost if I can avoid this. If I'm Foot qualified/certified I can get privileges for scopes, Achilles, midfoot/rearfoot tendon work and flat foot no problem?

2) I used Board Wizards but really didn't have the most time to study because of residency...I went through every question and CBPS case in the bank at least once. A friend of mine recommended DPMQuestions, said its more like the actual exam. Does anyone have any experience with this?

3) Do people who are starting after residency really have time to study or prepare for all of this? Every young attending I know keeps saying how being in PP is more busy than residency and that you have no time for anything...granted I live/do residency in a large city and some of these guys are doing office hours 6 days a week and multiple OR days a week. I am guessing this is not the case for everyone.

Thank you all in advance.

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[DYK343]

If you can get RRA get RRA even if you dont want to do that type of work.
It will greatly improve your job opportunities throughout your career.

 

[Boba Foot]

I'm currently in the process of applying for hospital privileges at a hospital in a large city. You do have to be ABFAS certified, but here are the procedures that just Foot ABFAS will allow:

• 1. Anesthesia (topical, local and regional blocks)
• 2. Application of external fixator to foot
• 3. Debridement of superficial ulcer or wound
• 4. Digital exostectomy
• 5. Digital fusions
• 6. Digital tendon transfers, lengthening, repair
• 7. Digital/Ray amputation
• 8. Excision of accessory ossicles, midfoot and rearfoot
• 9. Excision of benign bone cyst or bone tumors
• 10. Excision of sesamoids
• 11. Excision of skin lesion of foot and ankle
• 12. Excision of soft tissue mass (neuroma, ganglion, fibroma)
• 13. External neurolysis/decompression including tarsal tunnel
• 14. Hallux valgus repair with or without metatarsal osteotomy (including 1st metatarsal cuneiform joint)
• 15. Hammertoe correction
• 16. Implant arthroplasty forefoot & rearfoot
• 17. Incision and drainage /wide debridement of soft tissue infection
• 18. Incision of onychia
• 19. Metatarsal excision
• 20. Metatarsal exostectomy
• 21. Metatarsal osteotomy
• 22. Midtarsal and tarsal exostectomy (include posterior calc spur)
• 23. Neurolysis of nerves, rearfoot
• 24. Onychoplasty
• 25. Open/closed reduction of fractures, digital
• 26. Open/closed reduction of fractures, metatarsal
• 27. Osteotomies of the midfoot and rearfoot
• 28. Plantar fasciotomy with or without excision of calc spur
• 29. Polydactylism revision
• 30. Rearfoot fusion
• 31. Removal of foreign body
• 32. Skin graft
• 33. Soft tissue surgery involving a nail or plantar wart excision, avulsion of toenail, excision or destruction of nail matrix or skin lesion, removal of superficial foreign body and treatment of corns and calluses.
• 34. Syndactylism revision
• 35. Syndactylization of digits
• 36. Tarsal coalition resection
• 37. Tendon lengthening (non-digital) including gastrocnemius recession
• 38. Tendon rupture repair (non-digital)
• 39. Tendon transfers (non-digital)
• 40. Tenodesis
• 41. Tenotomy/capsulotomy, digit
• 42. Tenotomy/capsulotomy, metatarsal, phalangeal joint
• 43. Traumatic injury of foot and related structures

Here are the procedures that adding RRA will allow:

1. Ankle arthroscopy
2. Ankle stabilization procedures
3. Application of external fixator to foot
4. Arthrodesis – ankle joint
5. Arthroplasty, with or without implants, ankle joints
6. Fasciotomy of lower leg/ankle
7. Major tendon surgery of the foot and ankle such as tendon transpositionings, recessions, suspensions
8. Open and closed reduction fractures of the ankle
9. Osteotomy, tibia, fibula
10. Surgical treatment of osteomyelitis of ankle
11. Plastic surgery techniques involving midfoot, rearfoot, or ankle

I would say evaluate what you want to do with your career, and if the procedures under the RRA cert matter to you or not. The chances of passing ABFAS qual on retake is actually lower than passing the first time based on stats I've seen for retakes vs. first tries in the past. To me, the only procedures I might slightly feel like I'm missing out on are scopes and lateral stabilization procedures. Any ankle ORIF would likely go to Ortho on call anyway. Are just scopes and Brostroms worth dropping $1000 multiple times and hardcore studying for a second time, while trying to work a big boy job, to get RRA qual though? I'm not so sure.

 

[CutsWithFury]

I'm currently in the process of applying for hospital privileges at a hospital in a large city. You do have to be ABFAS certified, but here are the procedures that just Foot ABFAS will allow:

• 1. Anesthesia (topical, local and regional blocks)
• 2. Application of external fixator to foot
• 3. Debridement of superficial ulcer or wound
• 4. Digital exostectomy
• 5. Digital fusions
• 6. Digital tendon transfers, lengthening, repair
• 7. Digital/Ray amputation
• 8. Excision of accessory ossicles, midfoot and rearfoot
• 9. Excision of benign bone cyst or bone tumors
• 10. Excision of sesamoids
• 11. Excision of skin lesion of foot and ankle
• 12. Excision of soft tissue mass (neuroma, ganglion, fibroma)
• 13. External neurolysis/decompression including tarsal tunnel
• 14. Hallux valgus repair with or without metatarsal osteotomy (including 1st metatarsal cuneiform joint)
• 15. Hammertoe correction
• 16. Implant arthroplasty forefoot & rearfoot
• 17. Incision and drainage /wide debridement of soft tissue infection
• 18. Incision of onychia
• 19. Metatarsal excision
• 20. Metatarsal exostectomy
• 21. Metatarsal osteotomy
• 22. Midtarsal and tarsal exostectomy (include posterior calc spur)
• 23. Neurolysis of nerves, rearfoot
• 24. Onychoplasty
• 25. Open/closed reduction of fractures, digital
• 26. Open/closed reduction of fractures, metatarsal
• 27. Osteotomies of the midfoot and rearfoot
• 28. Plantar fasciotomy with or without excision of calc spur
• 29. Polydactylism revision
• 30. Rearfoot fusion
• 31. Removal of foreign body
• 32. Skin graft
• 33. Soft tissue surgery involving a nail or plantar wart excision, avulsion of toenail, excision or destruction of nail matrix or skin lesion, removal of superficial foreign body and treatment of corns and calluses.
• 34. Syndactylism revision
• 35. Syndactylization of digits
• 36. Tarsal coalition resection
• 37. Tendon lengthening (non-digital) including gastrocnemius recession
• 38. Tendon rupture repair (non-digital)
• 39. Tendon transfers (non-digital)
• 40. Tenodesis
• 41. Tenotomy/capsulotomy, digit
• 42. Tenotomy/capsulotomy, metatarsal, phalangeal joint
• 43. Traumatic injury of foot and related structures

Here are the procedures that adding RRA will allow:

1. Ankle arthroscopy
2. Ankle stabilization procedures
3. Application of external fixator to foot
4. Arthrodesis – ankle joint
5. Arthroplasty, with or without implants, ankle joints
6. Fasciotomy of lower leg/ankle
7. Major tendon surgery of the foot and ankle such as tendon transpositionings, recessions, suspensions
8. Open and closed reduction fractures of the ankle
9. Osteotomy, tibia, fibula
10. Surgical treatment of osteomyelitis of ankle
11. Plastic surgery techniques involving midfoot, rearfoot, or ankle

I would say evaluate what you want to do with your career, and if the procedures under the RRA cert matter to you or not. The chances of passing ABFAS qual on retake is actually lower than passing the first time based on stats I've seen for retakes vs. first tries in the past. To me, the only procedures I might slightly feel like I'm missing out on are scopes and lateral stabilization procedures. Any ankle ORIF would likely go to Ortho on call anyway. Are just scopes and Brostroms worth dropping $1000 multiple times and hardcore studying for a second time, while trying to work a big boy job, to get RRA qual though? I'm not so sure.

You can’t be a big boy if you can’t do all the cases your training allows you to do.

If you think you are working a big boy job but not doing all the cases your training affords you because you are too cheap or too dumb to pass the RRA qualifying exam then you are missing out on some big cash/RVUs.

Man up. Get RRA certified.

 

[wakaflocka88]

Honestly, I passed both parts qualifying the first time. Someone mentioned earlier and the best strategy is just selecting as much as you can for the dumb tests for the exam, diagnosis, labs, orders etc sections. Even if you select palpate DP and PT and it may say “non palpable” still pick the option that says “check cap refill time.” It’s truly dumb. I didn’t study for it. Thought I would fail but I used the same strategy above on all the ITE each year in residency and always scored high without studying.

I’d say take it again. And if you fail again, go to the ABFAS booth at a random meeting and give them the bird. It’s just another scam hurdle to cross but might as well do it so you don’t look back and wonder. Brostroms are my favorite procedure to do and it’s an easy 10-12 wRVU alone before a scope.

 

[Boba Foot]

You can’t be a big boy if you can’t do all the cases your training allows you to do.

If you think you are working a big boy job but not doing all the cases your training affords you because you are too cheap or too dumb to pass the RRA qualifying exam then you are missing out on some big cash/RVUs.

Man up. Get RRA certified.

Frankly, couldn’t care less about what someone thinks who talks like that.

 

[CutsWithFury]

Frankly, couldn’t care less about what someone thinks who talks like that.

Thank you for sharing your feelings.

 

[Shiyuan]

Thankfully where i’m at ABPM goes a long way. I don’t have to fart around with ABFAS.

... and I still get to enjoy me some of that free doctor’s lounge food 🤪🥳

 

[air bud]

I'm currently in the process of applying for hospital privileges at a hospital in a large city. You do have to be ABFAS certified, but here are the procedures that just Foot ABFAS will allow:

• 1. Anesthesia (topical, local and regional blocks)
• 2. Application of external fixator to foot
• 3. Debridement of superficial ulcer or wound
• 4. Digital exostectomy
• 5. Digital fusions
• 6. Digital tendon transfers, lengthening, repair
• 7. Digital/Ray amputation
• 8. Excision of accessory ossicles, midfoot and rearfoot
• 9. Excision of benign bone cyst or bone tumors
• 10. Excision of sesamoids
• 11. Excision of skin lesion of foot and ankle
• 12. Excision of soft tissue mass (neuroma, ganglion, fibroma)
• 13. External neurolysis/decompression including tarsal tunnel
• 14. Hallux valgus repair with or without metatarsal osteotomy (including 1st metatarsal cuneiform joint)
• 15. Hammertoe correction
• 16. Implant arthroplasty forefoot & rearfoot
• 17. Incision and drainage /wide debridement of soft tissue infection
• 18. Incision of onychia
• 19. Metatarsal excision
• 20. Metatarsal exostectomy
• 21. Metatarsal osteotomy
• 22. Midtarsal and tarsal exostectomy (include posterior calc spur)
• 23. Neurolysis of nerves, rearfoot
• 24. Onychoplasty
• 25. Open/closed reduction of fractures, digital
• 26. Open/closed reduction of fractures, metatarsal
• 27. Osteotomies of the midfoot and rearfoot
• 28. Plantar fasciotomy with or without excision of calc spur
• 29. Polydactylism revision
• 30. Rearfoot fusion
• 31. Removal of foreign body
• 32. Skin graft
• 33. Soft tissue surgery involving a nail or plantar wart excision, avulsion of toenail, excision or destruction of nail matrix or skin lesion, removal of superficial foreign body and treatment of corns and calluses.
• 34. Syndactylism revision
• 35. Syndactylization of digits
• 36. Tarsal coalition resection
• 37. Tendon lengthening (non-digital) including gastrocnemius recession
• 38. Tendon rupture repair (non-digital)
• 39. Tendon transfers (non-digital)
• 40. Tenodesis
• 41. Tenotomy/capsulotomy, digit
• 42. Tenotomy/capsulotomy, metatarsal, phalangeal joint
• 43. Traumatic injury of foot and related structures

Here are the procedures that adding RRA will allow:

1. Ankle arthroscopy
2. Ankle stabilization procedures
3. Application of external fixator to foot
4. Arthrodesis – ankle joint
5. Arthroplasty, with or without implants, ankle joints
6. Fasciotomy of lower leg/ankle
7. Major tendon surgery of the foot and ankle such as tendon transpositionings, recessions, suspensions
8. Open and closed reduction fractures of the ankle
9. Osteotomy, tibia, fibula
10. Surgical treatment of osteomyelitis of ankle
11. Plastic surgery techniques involving midfoot, rearfoot, or ankle

I would say evaluate what you want to do with your career, and if the procedures under the RRA cert matter to you or not. The chances of passing ABFAS qual on retake is actually lower than passing the first time based on stats I've seen for retakes vs. first tries in the past. To me, the only procedures I might slightly feel like I'm missing out on are scopes and lateral stabilization procedures. Any ankle ORIF would likely go to Ortho on call anyway. Are just scopes and Brostroms worth dropping $1000 multiple times and hardcore studying for a second time, while trying to work a big boy job, to get RRA qual though? I'm not so sure.

It's a few thousand dollars dude. Have some perspective. Do a few of those cases and even. I don't understand it.

 

[UNVME2]

I'm currently in the process of applying for hospital privileges at a hospital in a large city. You do have to be ABFAS certified, but here are the procedures that just Foot ABFAS will allow:

I will tell you from my own experience, that is not true. I can say now that litigation is over, I sued a hospital system in Boston and won when they told me ABFAS was the only board they recognized for podiatrists who wanted surgical privileges. Regardless of what your hospitals bylaws state, if they are accredited by CMS (medicare), there are laws the hospital must implement in their bylaws for privileging. While bylaws can state board certification is required within a 5 year period, they cannot mandate one specific board over another, as long as you are "board certified" in your primary profession.


Specifically, "CMS Conditions of Participation (CMS 482.12a7): Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely dependent upon certification, fellowship, or membership in a specialty body or society"

By law committees MUST consider you education and experience in addition to board certification, when considering privileges.

I am ABPM certified and graduated with a 3 year residency (PMSR/RRA). I cannot comment on everyones situation, experience or education, but I can tell you it is not necessary that you be ABFAS certified if you have been trained in forefoot/rearfoot.

 

[Shadowfax12]

I will tell you from my own experience, that is not true. I can say now that litigation is over, I sued a hospital system in Boston and won when they told me ABFAS was the only board they recognized for podiatrists who wanted surgical privileges. Regardless of what your hospitals bylaws state, if they are accredited by CMS (medicare), there are laws the hospital must implement in their bylaws for privileging. While bylaws can state board certification is required within a 5 year period, they cannot mandate one specific board over another, as long as you are "board certified" in your primary profession.


Specifically, "CMS Conditions of Participation (CMS 482.12a7): Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely dependent upon certification, fellowship, or membership in a specialty body or society"

By law committees MUST consider you education and experience in addition to board certification, when considering privileges.

I am ABPM certified and graduated with a 3 year residency (PMSR/RRA). I cannot comment on everyones situation, experience or education, but I can tell you it is not necessary that you be ABFAS certified if you have been trained in forefoot/rearfoot.

These threads just make me more confused lol

 

[CutsWithFury]

I will tell you from my own experience, that is not true. I can say now that litigation is over, I sued a hospital system in Boston and won when they told me ABFAS was the only board they recognized for podiatrists who wanted surgical privileges. Regardless of what your hospitals bylaws state, if they are accredited by CMS (medicare), there are laws the hospital must implement in their bylaws for privileging. While bylaws can state board certification is required within a 5 year period, they cannot mandate one specific board over another, as long as you are "board certified" in your primary profession.


Specifically, "CMS Conditions of Participation (CMS 482.12a7): Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely dependent upon certification, fellowship, or membership in a specialty body or society"

By law committees MUST consider you education and experience in addition to board certification, when considering privileges.

I am ABPM certified and graduated with a 3 year residency (PMSR/RRA). I cannot comment on everyones situation, experience or education, but I can tell you it is not necessary that you be ABFAS certified if you have been trained in forefoot/rearfoot.

How did you pull that off? Did you get ABPM involved? Did you get APMA involved?

Or did you just hire a lawyer and take it head on? I think this sets an important precedent especially in the New England area.

 

[Feli]

... really didn't have the most time to study because of residency...

If you think you'll have more time to study as an attending, that's pretty doubtful. You will basically be limited to weekends to read and take practice exams... maybe some quick CBPS at lunch or evenings (but not for hours of library on weekdays like residents usually can).

Probably try it again, but 90% of what you need to know for ABFAS didactic exams was taught in pod school (indications, complications, anatomy, gen med). The rest is in journals and CME lectures.

As for the case review, that part can be rough. There are a million ways to fail based on charting, xray quality, can't get records, etc. I was just talking to a buddy (great training, good fellowship, does much big stuff and does it well) who has failed cert cases multiple times on cases ticky-tack stuff. But for the objective parts (mult choice and CBPS), that is just old fangled book learnin... you can do it.

 

[UNVME2]

How did you pull that off? Did you get ABPM involved? Did you get APMA involved?

Or did you just hire a lawyer and take it head on? I think this sets an important precedent especially in the New England area.

The ABPM provided a list of attorneys specializing in credentialing/physician licensing. We settled and the hospital paid my lawyer fees. Its astounding some of these department heads in credentialing have no clue about credentialing laws and try to implement ACFAS only policies.

 

[CutsWithFury]

The ABPM provided a list of attorneys specializing in credentialing/physician licensing. We settled and the hospital paid my lawyer fees. Its astounding some of these department head DPMS have no clue about laws and try to implement ACFAS policies.

Great information!

 

[UNVME2]

These threads just make me more confused lol

Most of the confusion centers around DPMs being told they MUST have ACFAS certification to obtain surgical privileges. This is not true. The ABPM website has more information to read through if you are in this scenario.

 

[CutsWithFury]

Most of the confusion centers around DPMs being told they MUST have ACFAS certification to obtain surgical privileges. This is not true. The ABPM website has more information to read through if you are in this scenario.

Some states have them written into the bylaws for the state via the Department of Health. For example see Connecticut state bylaws. You can't obtain Ankle privileges in the state without ACFAS.

 

[diabeticfootdr]

The ABPM has resources for anyone who experiences discrimination of hospital/surgical privileges based on their certification. You can find it on the website or email HQ.

There are 2 separate issues being discussed above.

Hospital/Surgical Privileges
Hospitals are allowed to use BC to make privileging decisions if they follow the law, CMS conditions of participation, and other accrediting bodies (The Joint Commission). But they can't use BC as the sole criterion in privileging decisions. Your privileges must be based on your education, training, and experience. All podiatrists who have graduated from 2011-present have the same, standardized education and training. Your experience is the key differentiator. How many cases of X,Y,Z have you performed? Sometimes the case volumes are waived for new grads. Sometimes hospitals look at your residency logs. Hospitals are prohibited from only considering cases from their institution and must consider cases from outside institutions during the same time frame.

If hospitals require BC as an element of privileging, it must be BC in your primary specialty. Since podiatry has a single, standardized residency that leads to certification by either CPME-recognized board, either board is considered certification in your primary specialty.

Scope of Practice
There are 4 states (NY, CT, SC, OR) which limit a podiatrist's scope of practice based on board certification. ABPM is challenging these as this is discrimination against DPMs as a whole, since MDs legal scope is not determined by their board certification. For example, you don't have to be BC in dermatology to have the scope to treat the skin.

 

[msion]

I do encourage all new graduates to apply for ABPM certifications. It will open more doors for you and like what the others said above, in many cases you can actually fight for your privileges, and the ABPM certification will definitely help you.
In our hospital/s we actually modeled the podiatry privilege list after the ABPM sample by dividing into different core competenties. We simplified them though. Essentially ABPM certification will allow you to do 95% of the surgeries podiatry has to offer, and if you want to do ankle arthroscopy, total ankle replacement or complex Charcot surgeries then you will need ABFAS. I think that's pretty fair.

ABPM Sample Form

 

[CutsWithFury]

I do encourage all new graduates to apply for ABPM certifications. It will open more doors for you and like what the others said above, in many cases you can actually fight for your privileges, and the ABPM certification will definitely help you.
In our hospital/s we actually modeled the podiatry privilege list after the ABPM sample by dividing into different core competenties. We simplified them though. Essentially ABPM certification will allow you to do 95% of the surgeries podiatry has to offer, and if you want to do ankle arthroscopy, total ankle replacement or complex Charcot surgeries then you will need ABFAS. I think that's pretty fair.

ABPM Sample Form

Once ABPM gets outdated laws thrown out of CT, NY, OR and SC where they state you can only be ABFAS certified/qualified to do surgery I will start taking them more serious.

 

[Pronation]

I do encourage all new graduates to apply for ABPM certifications. It will open more doors for you and like what the others said above, in many cases you can actually fight for your privileges, and the ABPM certification will definitely help you.
In our hospital/s we actually modeled the podiatry privilege list after the ABPM sample by dividing into different core competenties. We simplified them though. Essentially ABPM certification will allow you to do 95% of the surgeries podiatry has to offer, and if you want to do ankle arthroscopy, total ankle replacement or complex Charcot surgeries then you will need ABFAS. I think that's pretty fair.

ABPM Sample Form

I think delineation of privileges for podiatry that have these "core competencies" are silly. You're either qualified to do all foot & ankle surgery or you're not.

 

[air bud]

I think delineation of privileges for podiatry that have these "core competencies" are silly. You're either qualified to do all foot & ankle surgery or you're not.

Aren't you the one who came at me hard a month ago for gate keeping? Need to find that thread. But yeah you are right

 

[Pronation]

Aren't you the one who came at me hard a month ago for gate keeping? Need to find that thread. But yeah you are right

Sir, I do not recall coming on you hard.

 

[CutsWithFury]

Sir, I do not recall coming on you hard.

Stick to your nail nippers Nancy. Men are talking here.

 

[air bud]

Sir, I do not recall coming on you hard.

Sir, I do not recall coming on you hard.

You win the internet's today

 

[Shiyuan]

Stick to your nail nippers Nancy. Men are talking here.

Forget the nippers... I’ll be rubbing dat foot lotion on dem feetsies 🥸

 

[AttackNME]

I do encourage all new graduates to apply for ABPM certifications. It will open more doors for you and like what the others said above, in many cases you can actually fight for your privileges, and the ABPM certification will definitely help you.
In our hospital/s we actually modeled the podiatry privilege list after the ABPM sample by dividing into different core competenties. We simplified them though. Essentially ABPM certification will allow you to do 95% of the surgeries podiatry has to offer, and if you want to do ankle arthroscopy, total ankle replacement or complex Charcot surgeries then you will need ABFAS. I think that's pretty fair.

ABPM Sample Form

I’ve actually considered dropping my ABPM certification, what’s the benefit if I’m already ABFAS certified in foot and RRA?

 

[icebreaker32]

I’ve actually considered dropping my ABPM certification, what’s the benefit if I’m already ABFAS certified in foot and RRA?

You can put on your website you are one of the few triple board certified podiatrists in the country and patients will line up to see you.

In reality it serves no use and is a personal decision if you want to keep it.

 

[CutsWithFury]

Forget the nippers... I’ll be rubbing dat foot lotion on dem feetsies 🥸

View attachment 356477

Ahhh yes the vital job of the mustache podiatrist that still lingers tormenting us all.

 

[CutsWithFury]

You can put on your website you are one of the few triple board certified podiatrists in the country and patients will line up to see you.

In reality it serves no use and is a personal decision if you want to keep it.

Ahhh yes triple board certified for such a small area of human anatomy. The ultimate podiatry over compensation.

I’m board certified in left 5th toe surgery. Only one in the country.

 

[SouthPod7]

Ahhh yes triple board certified for such a small area of human anatomy. The ultimate podiatry over compensation.

I’m board certified in left 5th toe surgery. Only one in the country.

Damn. I couldn't pass my case review for that one. You are truly one of a kind.