PMSR graduates achieving OR privileges

[Boots and Mittens Show]

With most programs being RRA at this point, how hard is it for a new PMSR grad to be granted OR privileges at hospitals? Is that currently being used to deny insurance coverage or hospital privileges for even forefoot surgery?

Just how big of a burden on a career will it be today to not have the RRA certification?

I feel that I could have a happy career without doing rearfoot recon and ankles, but am terrified that the lack of having a RRA certificate could harm me in the future and limit job/compensation opportunities.

Does anyone have any input on this topic?

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[ExperiencedDPM]

The harsh reality is that across the nation, the majority of surgery being performed by DPMs, despite their training, is not rearfoot recon. Yes, I know we can do it and do it, but the VAST majority of the podiatric cases do not involve RF recon. That isn't opinion, it's a fact. I'm a consultant to a few major insurance carriers and I see the stats and the breakdown. So you should not have a hard time obtaining a job or privileges for procedures you're trained in and can perform competently.

We've had many docs apply to our hosptial with impressive training but who didn't pass the grade obtaining certain privileges because when observed, they were obviously not ready to fly. Surgical privileges in many facilities is not an automatic simply because you have a surgical log from residency. You must also prove competency. I'm sure many of you out there know a resident that trained at your program, and despite that training, they still suck at surgery.

You either you have it or you don't. You can't make chicken salad out of chicken sh-t.

 

[air bud]

I am by no means disagreeing with ExperiencedDPM, and I wish this his example was the baseline in every hospital. At my hospital, which is in a town of 40k and about an hour from a city of 400k, nobody looked at my numbers. Nobody asked me about my training. I was board qualified and they gave basically everything I asked for (except for some political stuff....). Nobody in my town including ortho has scoped an ankle in about 8-10 years. I asked for privileges and at my review I said (did not show actual numbers) I did 39 during residency. The board voted and gave me privileges. So in my case, it was that automatic.

 

[Weirdy]

So it will vary pending location/politics/saturation and other details?

 

[NatCh]

Your privileges will depend on the guidelines of the hospital and surgery centers in your community. For example, my hospital is more restrictive and bases its privileges on ABFAS certification (basically, you need RRA cert to do anything proximal to the tarsometatarsal joint other than plantar fascia release and ostectomy, and Haglund's resection is permitted as long as you don't touch the Achilles).

One surgery center follows the hospital guidelines whereas another surgery center allows what is permitted by state law as long as one can show previous experience and competence.

If you'd be happy doing foot surgery without working on the rearfoot or ankle then you would likely be able to do the procedures for which you're trained without the RRA certification. Your local facility guidelines may vary, of course.

 

[ldsrmdude]

Just to add another anecdote, I work out of 2 hospitals and 1 surgery center. 1 hospital and the surgery center have their bylaws such that if you are 3-year trained you can get granted privileges for rearfoot/ankle. I don't think that board certification/qualification was a stipulation except maybe you had to prove that you were working towards it. The other hospital wouldn't grant me ankle privileges despite board qualification. It really can vary even within the same community

I don't think that not having the RRA credential is a death sentence. There are some notable physicians who have chosen to not do ABFAS board certification in the past