Restarting residency to obtain RRA

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NMD9317

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Hey Guys,

So I’m about to complete my residency program next week on the East Coast with a PMSR certificate. I was unfortunately guaranteed in my first year, by my previous immoral director, that if I obtain all my “RRA” numbers than I could obtain the RRA certificate. Due to my naivete, I believed him and obtained the diversity and case load to obtain the RRA cases. When I completed my numbers, I informed the CPME and they told me there wasn’t a way to obtain the certificate unless a spot was designated. I pleaded with my director multiple times to apply for the spot, but due laziness and a lack of regard for the residency he did not make any attempts to obtain the RRA designation. Needless to say, he eventually got tossed, however I’m still stuck without an RRA.

My dilemma now is now looking for a job. I love being in the hospital, being busy with all the interaction, teaching, and interacting with all the other services. So preferably, I would love to work at the hospital. The issues I now when I am looking for a job you need to have an RRA designation by the hospital requirements or the state scope prevents me to practice what I was trained to do.

Many of these jobs state the need to be BQ/BC in foot & ankle surgery or foot and reconstructive rearfoot/ankle. I’m assuming the latter was offered to PMSR 24/36 as I can only site for the FOOT certification, and cannot sit for the RRA since my residency did not designate a spot.

There are many things that are just utterly confusing. Firstly, on the ABFAS site it says that if you are BQ/BC then you “demonstrated capability in the diagnosis of general medical problems, including the diagnosis and surgical management of foot diseases, deformities, and/or trauma, and those structures that affect the foot and ankle.” So that definition includes the ankle, so If am performing surgery on the ankle and the certification states that I am qualified to do it, then what additional scope does the RRA technically give you other than semantics. Secondly, how is it possible that a PMSR 24 can sit for the RRA boards (as per ABFAS) however I cannot. I have 3 years of training and have all the cases for the rearfoot/ ankle as well as significant hands on experience on those cases. However, someone who may have never did an ankle orif or arthrodesis or scrubbed in with ortho while their residents did the case can sit for the boards?

My concerns are:

1) I’m sure not having the RRA is already a limiting factor, however If I make it to the next step how likely is it for me to get hired if I show my surgical log and have them proctor me for competency?

2) Is it worth contacting the ABFAS or any other governing body to potentially change the rule and allow those who have the numbers to allow to sit for the RRA designation?

3) Why is there even a PMSR designation? Eradicate that designation and make everyone have the RRA as the standard. I’m literally in limbo as my peers have the RRA designation, and my predecessors have either a different board certification (foot and ankle) or can sit for a designation (RRA) that they may or may not be qualified for.

4) I love what I do, but If I can’t perform my job as I was trained to after completing residency, what should I do? Is there any way I’m going to be able to practice the way I would like to? Should I just monitor caspr/crip for an advanced position to get an RRA? IS it worth as going as far as to re-entering the match and start over as a PGY-1?


I’ll admit, I’m feeling hopeless. Any help or suggestions would be appreciated.

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What I am finding is that a podiatrist's scope is defined by law, not by the letters in their residency program. Of course, for you to take on cases that you know you can't perform would be a violation of the law in most states under "professional misconduct." But if you're proficient in ankle ORIF, then you can do it.

Your privileges will be delineated by the hospital and surgery center. If they tell you you can't take ankle cases, just show them your case logs and you should be fine. Some university hospitals will make a big issue of the RRA cert. Some hospitals will say you can't do it even with the RRA cert because you're just a stupid podiatrist. :shrug: Plating a fibula ain't hard.

Biggest limitation is that you can never sit for the ABFAS RRA certification, which I don't know what it gives you other than bragging rights...
 
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I'm sorry, @NMD9317 that sounds like a terrible situation. I'd be hard pressed to redo residency to get RRA and I wish they would be willing to reconsider granting you RRA given you have the cases and diversity. Like @Adam Smasher said, one of your best options would be to sit down with your case logs and CPME 320 to show you meet the requirements of RRA even though it wasn't granted. It sounds like your director isn't invested in your education but would also be helpful to get a letter from them stating you meet the requirements of RRA and 'insert excuse' of why they didn't apply for it.

In the end, like all have said, it should be your proficiency that determines your scope not whether your director decides to apply for extra letters on the program or not.
 
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I think most of us will be doing diabetic foot care and limb salvage (and bread and butter stuff we all do on the foot like nails, calluses, bunions, hammertoes, plantar fasciitis) into the future, and that with foot certification you will be able to get surgical privileges at most hospitals and surgery centers. As was stated by Adam Smasher, you will probably still be able to do rearfoot cases that you are competent to do even without the certificate. At the hospital where I work, a rearfoot certificate isn't required to do rearfoot cases. It is only required that the surgeon has demonstrated competency. I don't recommend restarting residency to get this certificate. Again as Adam Smasher said, could you get the certificate, be board certified, well trained, and get trumped by an orthopedic foot and ankle surgeon for such cases? I've seen it happen where I work.
 
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Hey everyone, thanks for all the responses.

Ankle Breaker - Thanks for the advice for different scenarios. I will def. keep my eyes peeled for a potential advanced spot, just to get to the RRA to lift any other restrictions I have. Like some of the other guys said later posts, starting fresh may not be worth it, since there may always be some sort of potential roadblock. I definitely have been angry with the situation, however the anger is now sadness and regret. As much as I'd like to sue him for what he did to me and my colleagues, it still won't get us the certificate we deserve. Oh and just to touch on the subject of the RRA for more advanced training - I still would support that everyone should get an RRA, and eradicate the PMSR. I understand what you are saying, but we can compare it to like a hand fellowship; Some fellowships are heavy on micro and some are not. The guys are not will probably not really do micro when they are out. Or a ortho residency, maybe they got received lackluster training in foot and ankle and then they can pursue a fellowship for Foot & Ankle becasue they either have interest in it or they would like to receive better training in that area. I have done zero TAR, so I will never do one or attempt to do one unless I did a fellowship and did a significant volume as required to demonstrate expertise needed for the procedure.

Adam Smasher - Thanks for sharing your experience. I have to point out though, unfortunately the RRA letters are a limiting factor in several states. Two I can name off the top of my head are Colorado and NY, which won't let you touch the ankle without an RRA as per the state scope / regulations.

Pacpod and Creflo - Thanks for the reassurance and suggestions. I'm hoping that the hospitals can credential me for the procedures i have competence in. Also guys, if you don't mind me asking, what state do you guys practice in?

Quick question for you all - If there is a job posting and it is for an RRA should I still consider applying to it? And shoild I explain to them my situation in the cover letter or wait to tell them during the interview?

Thanks!
 
Unless anything has changes (in the past 10-20 years it might have). A conversion of residency takes 2 years after application. Site surveys are generally done no sooner than 2 years. So getting that changed would never help you after you have graduated. Same thing happened to me. My numbers made the residents 2 years later eligible for the RRA boards. Your welcome.
There should be a bigger push to make boards based on cases credentials not residency designation. 20 years ago, when most residencies were 1-2 years. I saw several 3 year programs with no action putting out RRA boarded DPMs. Meanwhile the ABPS/ABFAS was blocking guys who's numbers in a one or two your program blew the doors off 1/3 of the few 3 year programs. It's never made sense. Many of the most prolific podiatric pioneers in the profession have little or no residency training. And yet today we hold ourselves back to a ridiculous extent.
I don't think it's as self severing as most people accuse the board of. I believe its the massive inferiority complex in the profession, that drives the policy. So on paper we can say our training takes three years; not everyone gets the coveted surgical grail; therefore we are offering the public our best graduates as surgeons, now isn't that special.
You can fix an ankle in most states with foot certification. Just be careful where you take a job. yeapply for jobs you feel qualified to handle. There are still many places that have no idea that podiatry has 2 board levels and will privilege you based on your logs and recommendations.
 
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There are plenty of great advice that have been offered already. If this is not already mentioned, you should check the CASPRweb site for any advanced position. There are PMSR/RRA programs that have an opening for PGY-2 or even better PGY-3 position openings due to departure of a resident. Alternatively, you can reach out to a residency program to see if they have openings for PGY-2 or PGY-3 position, especially with programs that have been recently approved for either increased number of positions or conversion of a position from PMSR to PMSR/RRA. This would allow you to avoid repeating 3 years of residency training.
 
Terrible dilemma. Honestly I don't think you'll be able to change any of the rules to help your cause. It is pretty black-and-white in terms of what residency programs with and without the RRA certificate can and can't do. I think you would really struggle trying to get the rules changed.

I think the easiest thing for you to do is to get a paying job that maybe you can do for only a year. Then reach out to residency programs who have the RRA certificate and see if you can interview for a spot at the next CRIP in TX. Which would mean doing another three years.

Or get a paying job and keep your eyes peeled for advanced placement positions and apply for them and pray.

Or try and get a job in one of the most favorable states in the context of podiatry scope and try and stretch your residency training as much as you can to be able to do the cases that you want.

There are stories of podiatrists getting surgical privileges with the ABPM certificate.

Other than that I don't think hiring a lawyer and suing somebody's gonna do anything although if I was in your position I would be enraged and want to do something. But it won't accomplish anything so throw that idea out.

Terrible to hear!


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Come to Texas. I know guys not even board certified by ABFAS fixing ankles. They've got abpm qualification.
 
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