ABFAS pass rates suggest you will not RRA certify

[heybrother]

Right now over in the ABPM/ABFAS thread we have a battle rolling over the merits of ABFAS. Whatever the merits of ABFAS may be - a review of limited historic certification data suggests that only a small cohort of each class will RRA certify (Foot is slightly more favorable)

The argument I'm going to make here has nothing to do with job opportunities, "fair", "predatory", etc. It is - it is simply a commentary on historic certification rates.

The question in my mind that lead to this thread is - what would happen if the only people who took ABFAS were the same people who succeeded in ultimately certifying ABFAS. ie. a 100% certification rate through "perfect selection" with no failed candidates dropping off along the way, wasting their time/money, becoming frustrated etc.

I am only presenting ABFAS data.

Exam Pass Rates

Examination pass rate data from candidates undertaking the two-step process to earn ABFAS Board Certification

www.abfas.org

*First small thing - what are the odds that 456 people passed Foot 3 years in a row? I am open to that being a typo.

Didactic Image Here:
First off all - our data is somewhat limited. I'm not going to reach for data beyond ABFAS. I will perform a limited comparison based simply on trends of certain years while lacking other years. Above didactic data. What conclusions can be drawn from the data:

#1 - The first thing is there is a degree of self selection between people taking Foot and people taking RRA. These are the same class years so presumably these are in general the same people. It appears that approximately 90% of the people who take Foot also take RRA.
#2 - The second thing is that obviously the pass rate for RRA is substantially lower than the pass rate for Foot.
#3 - The third thing is - I don't know the graduating/matriculation rates for these years, but looking at the Foot applicant rate - I see greater than 500 students for each class taking the Foot certification test. My memory of reviewing AACPM data is that some years matriculated 600+ students. While I don't have exact data my big take home is that probably most residency graduates are ultimately pursuing ABFAS in some form or another ie. people want to be certified. Now perhaps the new ITE process means everyone tries figuring they might as well but for all the anecdotal talk of people not wanting to do surgery - a lot of people are pursuing surgical certification.

CBPS image here:
The CBPS data doesn't relay anything substantially new - the cohort size seems in line with the didactic sizes above (in general).

Foot Case Review Image:
#1 - Presumably (?) - individuals who pass the case review will likely certify though you can technically sit for case review by passing Part 1, but failing all portions of part 2. Obviously that would be tragic. I am somewhat viewing passing case review as a proxy for certification.
#2 - The general trend from the data suggests most people who sit for case review ultimately pass.
#3 - If you look at the residency years cohorts - the values you see for certain years are "done" ie. if you only have 7 years then no further people can sit from 2014-2016. Those values will not change. 2020 Graduates meanwhile will continue to acquire cases so the values in both N and Pass will continue to increase.
#4 - I obviously do not have data here for the number of people from earlier years who sat for didactic. However, if the values for historic didactic ie. 500ish grads, are similar to current didactic then even though the "case review pass rates" are about 80ish% - the number of people ultimately certifying in foot would be substantially beneath the number of people who started the process. For 2014-2016 - if 500ish graduates took didactic for foot then the ultimate proxiy pass rate through case review would be ~50%. Again, I don't know what number the didactic started with but there's a big drop off.

RRA Case Review Image:
#1 - Some of the same sorts of conclusions from above can likely be applied here. Theoretically case review is a proxy for certification. However, pass rates are lower compared to the rates for those who sat for Foot. Again, certain years are "done" and will have no further graduates. And again - more recent years are still acquiring cases.
#2 - I don't have data for the number of people who sat for didactics for most of these years, I acknowledge that above. If the numbers for historic years are comparable to the numbers for current years (ie. 500ish people started the process) then using RRA case review as a proxy will show a overall certification rate of less than 30%. Obviously there's a lot of assumption/extrapolation there.
#3 - On a small amusing note - my "anecdotal" feeling was that almost none of my classmates are RRA certified even though we are now several years out. In fact, there are fewer than a "podiatry school" of RRA students from my residency years.

ANYWAY. That's my rough data look. Perhaps someone with actual data can actually refute.

Let's go back to the thread title. "Reviewing historic ABFAS cert pass rates suggests you will not be RRA certified" (had to shorten to post). I chose not to touch foot in the title. I think the statistics through time are painful and I don't think the thread title is unreasonable based on what I had to work with.

Reading people's feelings on both sides of the ABFAS spectrum - its fascinating.

-If you believe ABFAS RRA helped you get a job - the simple truth is having it makes you part of a very small cohort.
-If you believe ABFAS is a scam - its hard from looking at the data not to see a massive subsidy being performed through paid testing that ultimately won't lead to certification. Essentially almost an entire class size/cohort is taking ABFAS's didactic testing but in the end only 30-50% of the class is becoming certified. There are hundreds of people per year comitting to some form of Foot/RRA testing to the tune of again hundreds of dollars who will have nothing to show for it.
-I wonder if I somehow had the current graduating class in front of me and I could poll them and ask "who here thinks they will be certified" - what would they say? How would they feel potentially seeing this historic data.
-Last of all, my suspicion is that some people would view this data as supporting the idea that the current residency RRA system is broken ie. so many 3 years graduates many with trivial RRA experience. That in fact we should go back to Foot and RRA to allow the RRA to be pooled to a smaller cohort.

Thanks for reading.

I may continue to correct small typoes after posting this. Unfortunately I could not post this with the images within the document.

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[air bud]

I think certainly a straight line can be drawn between your hypothesis and the transition to 3 year rra residencies.

 

[Bored Snorlax]

SDN really needs a bookmark functionality so I can read all of heybrother's posts at my leisure.

Edit: nvm they have one lmao.

 

[podgal2003]

I find your comment about 100% pass rate intriguing. Forgive me if I missed a nuance in your post.

RRA is for the most advanced training and is most inclusive scope. I don’t believe that residencies are meant to prepare and expose residents to every iteration of RRA performance, it takes time and repetition to get the nuances and background to pass RRA. That doesn’t include everyone but many are trying to hit that mark having less than three years of experience. It’s more than book learning and test taking. From the data presented, it’s not realistic. This goal is over emphasized for a resident with 2 1/2 years of training.

I believe a paradigm shift (this is not a new idea) is in order and strongly support a single pathway which would encourage all grads to pursue ABPM certification within the first year. They then gather cases and get ABFAS (foot) within a few years. Only after performing more cases and getting additional experience do they pursue RRA - more of a niche achievement.

Many along the way would be happy with just ABPM. Many would be satisfied in practice with ABFAS foot. This would decrease the overall numbers pursuing RRA and lead to the smallest most experienced cohort taking RRA. Theoretically it could lead to more people spending less money and increased pass rates.

I also believe ITEs should mirror this. PGY1 takes a combined ABPM/ABFAS exam. PGY2 takes ABPM and PGY3 takes ABFAS foot (college and residency prepares for this) for qualification. Save pursuing RRA until a little later.

You presented a lot of great data. My thoughts do not comment on it all. There are exceptions to my scenario. I’m trying to stay out of the politics and discussion of boards making money. It’s another talking point on a forum looking to understand our current status and encourage changes.

 

[FootGuy]

I find your comment about 100% pass rate intriguing. Forgive me if I missed a nuance in your post.

RRA is for the most advanced training and is most inclusive scope. I don’t believe that residencies are meant to prepare and expose residents to every iteration of RRA performance, it takes time and repetition to get the nuances and background to pass RRA. That doesn’t include everyone but many are trying to hit that mark having less than three years of experience. It’s more than book learning and test taking. From the data presented, it’s not realistic. This goal is over emphasized for a resident with 2 1/2 years of training.

I believe a paradigm shift (this is not a new idea) is in order and strongly support a single pathway which would encourage all grads to pursue ABPM certification within the first year. They then gather cases and get ABFAS (foot) within a few years. Only after performing more cases and getting additional experience do they pursue RRA - more of a niche achievement.

Many along the way would be happy with just ABPM. Many would be satisfied in practice with ABFAS foot. This would decrease the overall numbers pursuing RRA and lead to the smallest most experienced cohort taking RRA. Theoretically it could lead to more people spending less money and increased pass rates.

I also believe ITEs should mirror this. PGY1 takes a combined ABPM/ABFAS exam. PGY2 takes ABPM and PGY3 takes ABFAS foot (college and residency prepares for this) for qualification. Save pursuing RRA until a little later.

You presented a lot of great data. My thoughts do not comment on it all. There are exceptions to my scenario. I’m trying to stay out of the politics and discussion of boards making money. It’s another talking point on a forum looking to understand our current status and encourage changes.

I can't say I hate this idea, but the one "flaw" in this model would be the cost of taking both exams as a new doctor starting out, and possibly the annual fees for 2 organisations instead of 1 and additional "maintenance of certification" requirements, which basically double.

That aside I think it makes complete sense. Personally, I never sought ABPM cert. because I felt ABFAS was the one that really mattered. At the 3 year mark, I submitted only foot cases to ABFAS and passed the first time around. I didn't feel quite ready to submit the RRA cases and wanted more time to collect cases (along with feeling that breaking the case documentation into 2 would be less taxing). In year 6 I submitted RRA cases and also passed first time.

Based on my personal timeline, it fits pretty closely to the recommendation and seems to make sense with how I felt about it throughout the process.

If I had to go back I probably would've done ABPM out of the gate just to take some of the pressure off, but in the end it worked out and I was able to achieve both Foot and RRA with ABFAS so it doesn't really matter now. We have all had the same complaints about ABFAS being "rigid" in the past, but I do feel like the process has become more fair and can speak from experience that it is possible to pass with only 1 attempt for each case submission. I think the biggest issue is saving everything for so long in the event it's picked. If able to do that, the process is doable. I understand if moving jobs it isn't easy to get after the fact, but I was lucky to find a good fit initially.

I don't really have any "political issues" with either board, aside from personally believing the CAQ is a joke and should not be included as an option. The biggest issue seems to be the personal agendas in my opinion. If both boards "stayed in their lanes" this idea would possibly work, but there lies the problem. ABPM should not be pushing for abolishment of ABFAS and ABFAS should not be sending diplomates to hospitals trying to "derail" privileges of other non-member podiatrists. As an ABFAS member, I would prefer we take the high road and stand on the accomplishment.

Great Ideas Overall and a Great Post.

 

[air bud]

I think the second you have enough cases you submit. Not everyone passes first time.

 

[Feli]

.... I think the biggest issue is saving everything for so long in the event it's picked. If able to do that, the process is doable. I understand if moving jobs it isn't easy to get after the fact, but I was lucky to find a good fit initially....

Yeah, for sure. The process is very doable. I don't believe it's unfair.

The tests are not too hard to pass right out of training, especially if one has good training... but the texts and article info and practice materials exist for 100% of DPMs to read.

After that, it's basically a documentation game for BC, though. The advice I always give it so stay at one job until ABFAS BC (what you did) or download or screenshot ALL of the notes, XRs, etc for cases when you leave a job. Hope to heck you have a connection at any job you leave if you couldn't get all of your case info or it turns out you forgot something.

That basically leaves only a couple of paths out of residency:
-hospital job (operative job... most ppl can't get one out of residency - if ever)
-group job with fairly high volume surgery (most people can get that... but most statistically won't stay)

ABFAS also basically rules out what many DPMs consider the best and most lucrative job of all: starting your own office.
Whether that's out of residency or rapidly afterwards while in the BQ period, it makes BC chances get dicey. It's a big wild card that you'll get enough cases quickly enough in a solo office, particularly RRA cases. I suppose office buyout might be an option to have some volume faster, but like finding hospital jobs, that kind of $ will be a miniscule % of grads who can pull that move. Of all the DPMs that I know who started their own office (organically, taking over for mom or dad doesn't count), only one got ABFAS RRA cert... a few Foot cert, majority have no ABFAS at all. We are talking entrepreneur-from-residency ppl or 1yr associate and then solo docs who trained DMC, my program, PI, various top flight residencies, etc. It's just very tough to BC in solo startup PP. Some had trouble finding enough patients and refers early on, some were just too busy to document well or changed EMR, a few didn't have XR in their office early on and wouldn't meet case review guidelines (first post op XR within 1wk, etc). Their co-residents who did hospital or other MSG/pod/ortho group employ jobs indefinitely - or at least for an extended span before going to solo PP - did pass BC. That's unfortunate... because owner DPM is a great practice quality and financial move for a lot of people. It shouldn't have to be delayed or avoided because of the BC structure and timeline.

As it sits, an early job change or two - or solo PP - makes ABFAS cert very tough. The lost documentation or getting the volume fast enough trips people up, regardless of if the person can take tests or do surgery well. It's a documentation game. The process might be more fair now with ABFAS vs ABPS days, but it's also a lot weaker cert process overall without face to face exams. If they'd just require we pass written exams for BQ, have hospital logs of cases, and discuss cases with senior surgeons for BC (like ortho... and every other MD specialty), that'd go a long way to opening it up to many more DPMs of various practice settings/choices. They'd also get a good look at candidates' thought process, as opposed to just typing, downloading, uploading skills.