Cert results

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New CBPS exam resulted in 3 weeks
Case review took 9 weeks from due date of submission for both foot/RRA
 
Results are in!
This is beyond wild (managed to get a 490/500 on both cert parts a few years ago Foot and now RRA)...

abfas 2025.jpg



This was my only attempt on RRA cert, but I think I will just let this RRA one be done with as I'm getting closer to retire, very few docs in my area are even ABFAS Foot cert, and I'm not ever needing hospital/org jobs anymore. I thought it'd be fine to try for as I do the cases.

I lost points on almost every case for not documenting patient satisfaction. I'd guess that's something new... not sure who works full time and does that in each chart?

...Does anyone know if it costs more to renew board cert ABFAS for Foot ($440) vs renew for Foot + RRA?
It seems excessively dumb to challenge this and risk $ just to get a cert that'd cost me more money.

This is what I was thinking would be the worst case situ:
pass RRA is ok (maybe just costs more $$ to renew until I retire),
fail RRA with a no-even-close score would've been fine too (didn't need it anyways)
...but I'd figured the 470 or 480 or 490 is fairly rough outcome as I could challenge... but little or no real reason to. Hrmm.
 
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Feli said:
This is beyond wild (manage to get a 490/500 on both cert parts)...

View attachment 404504


This was my only attempt on RRA cert, but I think I will just let this RRA one be done with as I'm getting closer to retire, very few docs in my area are even ABFAS Foot cert, and I'm not ever needing hospital/org jobs anymore.

I lost points on almost every case for not documenting patient satisfaction. I'd guess that's something new... not sure who works full time and does that in each chart?

...Does anyone know if it costs more to renew board cert ABFAS for Foot ($440) vs renew for Foot + RRA?
It seems excessively dumb to challenge this just to get a cert that'd cost more money.
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I thought you're RRA already. Sorry to see this!
 
podiatryresident said:
I thought you're RRA already. Sorry to see this!
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No, I'd never tried RRA... been qual in it awhile (since residency). I failed Foot cert once and then passed it 2nd try a few years ago.

It is definitely the things you think are so important when employee that you could then pretty much care less about once owner. 🙂
 
Barely failed, would’ve passed if I documented patient satisfaction..are you kidding me???

If insurance companies don’t even care about documenting that, then why would I give af about putting it in my notes?
 
PointyNippers said:
Barely failed, would’ve passed if I documented patient satisfaction..are you kidding me???

If insurance companies don’t even care about documenting that, then why would I give af about putting it in my notes?
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Yeah, that has to be new this year ... I remember nothing of it in years past.

It really is more of a test of charting/docu than xrays/results.

I would tend to think that if pts do 1 year or more f/u and do hwr with me that they were not unsatisfied? Lol.
 
I always make sure to document that the patient is happy or unhappy with their results in post op progress notes as we all should in today's medical/legal climate. BUT, If I would have been failed for not including that- especially with something as hard to achieve as RRA, I would certainly appeal as there is absolutely no mention of requiring it that I can recall in the certification document.
 
If someone has a link or document that has “patient satisfaction” documentation as a requirement mentioned anywhere, that would be great
 
So, I passed my RRA but failed my foot. 470/500. Dinged for patient satisfaction, Dinged presumably for not putting an ambulatory patient on blood thinners. Patient developed a DVT 6 weeks post metatarsal osteotomy.

Also heavily Dinged for a BL lakewater-contaminated open lisfranc fracture dislocation with cuneiforms also having been dislocated in opposite directions. Patient wanted to return home to the other side of the country for definitive care. I only did provisional pin fixation. They didn't like the look of my mini C intra-op films and I didn't get full post op films. Also didn't like my post op documentation. Patient was flying home the next day.

Also Dinged for not getting pre op films on a bunion. I mean, sure. But if they don't want the x-ray, how "medically necessary" is it?
 
AttackNME said:
There has to be more than just patient satisfaction, what else you leaving out man?
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No, this is a new thing... never saw it on past exams:

They're not saying you have to do AOFAS score surveys per se, but you do get docked points. I lost 10pts each on multiple cases for this:

"Outcomes (Final Post-op) / Patient Satisfaction / Patient satisfaction is not documented or is not satisfied with the outcome."

(all of mine that were docked for this had "healed well ... back to shoes... did PT... returned to work/sport... etc" in progess notes as appropriate)
...but apparently satisfaction was not documented (and it's nowhere in the instructions on case review or the example progress notes from what I see). Dunno.

satisfaction.jpg

(and obviously, almost nobody would say "patient not satisfied" in a chart, so this is just failing to document something I don't think they tell you that you have to?)
 
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jehjr said:
...Dinged for not getting pre op films on a bunion. I mean, sure. But if they don't want the x-ray, how "medically necessary" is it?
...and I didn't get full post op films.
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This will fail you 100% of the time, just fyi (don't "fail" per se... but you lose points, usually multiple docks for pre op eval and eval of corrction for no pre op XRs or no weightbearing without letter that WB films not availble at your hospital/center). It's also good to get pacu XRs on everything (fixation) in case the pt has a fall or doesn't ever f/u.

I failed a couple years ago as I uploaded wrong side pre op (had to challenge and send correct side, had taken bilat at new pt visit).

I also lost points this year for not getting calc axial on flatfoot recons and not getting a calc axial on one calc fx final. You are supposed to get pre and final post (not just ankle and foot XRs) for any calc osteotomies or fx. That's right there in instructions.

...but the pt satisfaction thing, yeah... mind blown. There are no instructions on this that I can find. It's a new thing.
$4k challenge is not much to me and I have a 490 with multiple cases docked on satisfaction (and other things that could be challenged), but what a joke. Concur.
 
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PointyNippers said:
If someone has a link or document that has “patient satisfaction” documentation as a requirement mentioned anywhere, that would be great
Click to expand...
Yeah, I have no idea.... I looked and could not find it. This is the example docu. There is nothing on satisfaction in candidate guides either.

I'd be cool with it if the pt satisfaction's clearly a required thing and in their powerpoint, docu examples, list of requirements... but it seems new this year and arbitrary way to dock ppl points.

I have a feeling a LOT of people will be griping about this mystery new deduction... maybe I will challenge. Dunno.
 
skip43 said:
Anyone know how common it is to pass after an appeal?
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It totally depends how many points you need to make up (10pt = one deduction/dock issue)...
... depends even more on what your logic is for should not have lost the points.
Your success rate on appeal will obviously be 0% or it'll be 100%.
You do get the $4k back if you pass on appeal.

The only one I challenged was Foot cert a few years ago where I had uploaded right pre op XR for a left Lapidus (or the opposite). I got docked on that case for pre op eval and correction and etc because there was no pre op XR. I had been starting my own office and was going fast on the uploads and collecting the documents. I was at 490/500... so challenged a few thing but mainly just with adding the correct side pre op XR on that case, and passed.
 
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Congrats all who passed!

This pt satisfaction grading point is a new issue, and I should know as it took me 3 years of trying. I do always ask patients at final follow up, "what % better do you feel?" Because pts who are 6 months out will tell you how their bunionectomy still has occasional twinge of pain, and if that's all you document then that's all the abfas will conclude you've done for them.

However if I left a pt feeling 80% better, would abfas deduct points for <100% improvement???
 
Patient satisfaction should never be grounds for point deduction. The point of the case review is to evaluate your work up of a pathology, execution of surgery and management of the surgery or complications in the post op period.

Documentation on patient satisfaction for medico-legal reasons is outside the scope of the exam. It is beyond comprehension. It is hard to believe honestly. If you got dinged for this on multiple cases and that caused you to not pass this is grounds for a lawsuit.
 
Fortunately was able to pass 1st try. Agreed the satisfaction is BS. I add that because I figure it's nice CYA material. But had I failed based on that I'd be pissed. I never saw anything about that and I read and reread the instructions, PowerPoint, and examples. The instructions were crap. The process is so flawed.
 
Retrograde_Nail said:
Patient satisfaction should never be grounds for point deduction. The point of the case review is to evaluate your work up of a pathology, execution of surgery and management of the surgery or complications in the post op period.

Documentation on patient satisfaction for medico-legal reasons is outside the scope of the exam. It is beyond comprehension. It is hard to believe honestly. If you got dinged for this on multiple cases and that caused you to not pass this is grounds for a lawsuit.
Click to expand...

I mean there’s no lawsuit here, but this is just more evidence on how dumb ABFAS is. You shouldn’t even lose points for a patient who is ambulatory post-op, with no risk factors and therefore no anti-coag, who gets a DVT, that gets caught and treated appropriately. You can literally follow standard of care and lose points on case review. Insanity. But losing points for not documenting how satisfied you left the patient…?…the grading system or the graders themselves are a joke. Thank god I don’t need their cert for anything at this point in my career.
 
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Feli said:
...Does anyone know if it costs more to renew board cert ABFAS for Foot ($440) vs renew for Foot + RRA?
It seems excessively dumb to challenge this and risk $ just to get a cert that'd cost me more money.
Click to expand...
The fee remains the same if you add RRA. Just 2 tiers of certified and qualified fees. But who knows if they will change it.

Use the $4k to buy bonds, contribute to Roth, heck even buying a fancy smart fridge would yield better ROI.
 
Will be sending a letter to ABFAS to explain and prove that these patient satisfaction point deductions were even mentioned in their criteria. I suggest everyone do the same, otherwise this will keep happening.
 
I was planning for foot cert, but so far I’m mostly doing diabetic foot surgery so not sure if I’ll meet the criteria anytime soon. Wondering if I should just get ABPM and be done with it. Hospital doesn’t care what I have.
 
MicroPod said:
I was planning for foot cert, but so far I’m mostly doing diabetic foot surgery so not sure if I’ll meet the criteria anytime soon. Wondering if I should just get ABPM and be done with it. Hospital doesn’t care what I have.
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If you're doing diabetic foot surgery you 100% should be able to get enough cases for certification. Hindfoot fusions/nails. Tendon transfers etc.
 
MicroPod said:
I was planning for foot cert, but so far I’m mostly doing diabetic foot surgery so not sure if I’ll meet the criteria anytime soon. Wondering if I should just get ABPM and be done with it. Hospital doesn’t care what I have.
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If the hospital don't care get abpm to start then assess your case load and see if you go abfas
 
air bud said:
If you're doing diabetic foot surgery you 100% should be able to get enough cases for certification. Hindfoot fusions/nails. Tendon transfers etc.
Click to expand...
It’s been mostly amps and I&Ds so far. A couple of tendon transfers and offloading surgeries. A few bunions and 1st MPJ fusions, etc. I’m still ramping up my patient load, currently about 15 patients a day on clinic days, though a couple usually no show. 1-3 cases a week on average.
 
MicroPod said:
I was planning for foot cert, but so far I’m mostly doing diabetic foot surgery so not sure if I’ll meet the criteria anytime soon. Wondering if I should just get ABPM and be done with it. Hospital doesn’t care what I have.
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1. There's plenty of time to get cases. Diabetics need 1st ray work too.
2. Start by simply knocking out CBPS as soon as possible. Don't wait 5 years to take CBPS, fail something and tell yourself you can't do it. Just immediately get the test taking part out of the way. Even if you fail it - immediately take it again at the next cycle. There is nothing that I am aware of stopping a 1st-2nd year attending from just taking the tests right away.
3. The longer you wait to sit for Case Review the more logging you have to do and the more likely there's a problem or an issue or something stupid along the way.
4. If you want it - just work like you are going to get it and you are putting the steps in.
5. I told myself a myriad of things ranging from "I don't need ABFAS" to "ABPM is fine - none of my hospitals care" to "I'll just get ABPM as a safety until I get ABFAS". I'm not going to bash on ABPM. There's nothing wrong with doing both but you will be setting yourself up for (a) more tests (b) more money (c) more yearly MOC/points/renewal dollars etc. You are semi-likely to also have to do the ACPM educational college thing where you may earn some of your MOC points if you also do ABPM. There's an additional cost associated with this, but its also I'm told a very affordable way to get CME.
6. Yes, ABPM additionally gives you the ability to say you are board certified (probably sooner). There are good people who've done both and maintain both.
7. I'm writing this somewhat as a - how to pursue this directly. If you do the me thing and are wishy washy - its just more work.

Not knocking ABPM. Have spent plenty of time making fun of ABFAS - especially the RRA rates. But if you want to be ABFAS - just pursue it. Read their rules. Do the work. Get it and be done. If you attempt to float back and forth and be indecisive you'll take longer and spend more money and have more hassle. And ABFAS truly is a lot of work to get. When you open that case review email - your life is about to be spoken for.

I literally did my case review and then did a Medicare audit the next week. Embrace the suck.
 
MicroPod said:
It’s been mostly amps and I&Ds so far. A couple of tendon transfers and offloading surgeries. A few bunions and 1st MPJ fusions, etc. I’m still ramping up my patient load, currently about 15 patients a day on clinic days, though a couple usually no show. 1-3 cases a week on average.
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Then you are not being aggressive enough if you consider diabetic stuff just amps and incision and drainages.... And that's okay, it's part of the learning process.

You don't just amp a second toe anymore. It's a gastroc it's fixing the other toe deformities. Why did this happen how do you prevent other toes from going bad. Are you reacting or preventing.

Edit - it's TA tendon transfers after a partial 4th/5th ray amp causing lateral instability....ignore Feli and his diabetic stuff is 1st year cases
 
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air bud said:
Then you are not being aggressive enough if you consider diabetic stuff just amps and incision and drainages.... And that's okay, it's part of the learning process.

You don't just amp a second toe anymore. It's a gastroc it's fixing the other toe deformities. Why did this happen how do you prevent other toes from going bad. Are you reacting or preventing.

Edit - it's TA tendon transfers after a partial 4th/5th ray amp causing lateral instability....ignore Feli and his diabetic stuff is 1st year cases
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Thats what diabetics need - new incisions and procedures so they can get infected and end up with a bka
 
Gastroc recession, Keller, sesamoid planing, floating osteotomy--all doable MIS, and I've had more success than failures.

Tendon transfer/fusions and anything else requiring implants in a patient with HgA1c > 8 sounds dicey to me.
 
Adam Smasher said:
Gastroc recession, Keller, sesamoid planing, floating osteotomy--all doable MIS, and I've had more success than failures.

Tendon transfer/fusions and anything else requiring implants in a patient with HgA1c > 8 sounds dicey to me.
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@Retrograde_Nail is doing ankle fusions, charcot recon all MIS.
 
It’s not dicey.

Everyone in the room knows these patients are gonna lose their leg if they’re not dealt with surgically for offloading or reconstructive surgery. But people like to hide behind an A1c.

If this is how you practice then do not do limb salvage surgery because you’re doing a grave disservice to the patient .

This is what bugs me about podiatry because we have so many different podiatrist. Who say they do Wound Care and limb salvage, but it really is just debridement and skin substitutes and no surgery because they are too afraid to operate if the A1C is not perfect.

Learn MIS
 
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Retrograde_Nail said:
It’s not dicey.

Everyone in the room knows these patients are gonna lose their leg if they’re not dealt with surgically for offloading or reconstructive surgery. But people like to hide behind an A[emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]c.

If this is how you practice then do not do limb salvage surgery because you’re doing a grave disservice to the patient .

This is what bugs me about podiatry because we have so many different podiatrist. Who say they do Wound Care and limb salvage, but it really is just debridement and skin substitutes and no surgery because they are too afraid to operate if the A[emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]C is not perfect.

Learn MIS
Click to expand...

Thank you! I have felt this way since I finished residency, if they are going to lose their leg anyways you might as well do whatever you can to try and save it. If it doesn’t work they end up losing their leg anyways, but at least you tried. Just document the hell out of it and that you had this exact discussion with them!
 
PMG03470 said:
Thank you! I have felt this way since I finished residency, if they are going to lose their leg anyways you might as well do whatever you can to try and save it. If it doesn’t work they end up losing their leg anyways, but at least you tried. Just document the hell out of it and that you had this exact discussion with them!
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You are going to get sued an incredible amount, and lose everytime. Diabetics love to blame everyone but themselves when things go wrong.

Their attorney will always have 10 experts to say "there was no need to operate on the calf" when the patient had a toe ulcer.
 
GreenHousePub said:
You are going to get sued an incredible amount, and lose everytime.
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Document document document. Always have a in depth conversation. Leave no stone unturned. Thouroughly discuss the risks. Let the patient know "we are in limb salvage mode - this is risky but as is you are headed towards an amputation and I am trying to prevent this"

GreenHousePub said:
Diabetics love to blame everyone but themselves when things go wrong.
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I have actually seen the exact opposite in my practice
So many people dont give them the time of day
When someone actually tries they see hope.

GreenHousePub said:
Their attorney will always have 10 experts to say "there was no need to operate on the calf" when the patient had a toe ulcer.
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Present the literature to back up calf lengthening for forefoot ulcer.
Present the consent
Present the preop documentation on what I stated above.
No attorney will win that if youre documentation is in place.
 
GreenHousePub said:
You are going to get sued an incredible amount, and lose everytime. Diabetics love to blame everyone but themselves when things go wrong.

Their attorney will always have 10 experts to say "there was no need to operate on the calf" when the patient had a toe ulcer.
Click to expand...

You are everything that is wrong with limb salvage podiatry

Read a book

Or do residency again
 
Retrograde_Nail said:
You are everything that is wrong with limb salvage podiatry

Read a book

Or do residency again
Click to expand...
As others have mentioned - I’ve found my diabetic high risk patients to be very happy someone just wants to take an interest in actually helping them.
 
DYK343 said:
Present the literature to back up calf lengthening for forefoot ulcer.
Present the consent
Present the preop documentation on what I stated above.
No attorney will win that if youre documentation is in place.
Click to expand...
Except that's not real life.

Their gonna show a patient to a jury who has no idea what diabetic foot infections are, and will only see that the patient went in for a toe amp and you proposed 500 procedures to line your pockets.

Your insurance is going to want to settle ASAP.
 
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