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I'd like to extend a warm welcome to all of our new members who started their programs this week.
Podiatric residency education can be the most interesting and satisfying time of your career as a podiatrist. It can also be a living hell.
Part of what we do here at PRESENT is to help you make the most of your residency education experience, and ease you through the
difficulties you encounter in the next few years.
Once a week, on Tuesday night at 9:00 pm EST, we broadcast this "New Docs on the Block" ezine to all the podiatric residents,
residency directors, and hospital attendings at podiatric residency programs around the country. It also goes to hundreds of folks
in the industries that support the podiatry profession, as well as the leadership of podiatry associations around the country.
We´ve been publishing "New Docs" for over a year now, and of course, we archive all the past issues on the PRESENT Courseware website,
and there is an incredible wealth of great advice and information for you already there. Check it out any time by going to
www.podiatricresidency.com and selecting "Publications" on the left hand side menu.
We received some very interesting letters from you guys over the last few weeks, so I decided to show them all to you in this issue.
Best of luck with your programs this year!
Talk to me,
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
***Transfusions***
It's interesting - your commentary. As a resident at a teaching hospital, I wouldn't think twice about transfusing a patient ... of course while
conferring with internal medicine. I think when I get out, I'll probably do it even though it is out of scope.
Sincerely,
Michelle Koo, DPM
Chief resident pgy-3
Mt. Sinai Medical Center, Miami Beach, Fl
[email protected]
***Transfusions AND Scope Of Practice***
I admire your devotion to this patient (he sounds like one of our VA guys). However, you might want to check Michigan law to see if what you
did is within your scope for next time - because there will be one.
Good luck.
Jeffrey Ali, DPM Cleveland VAMC
[email protected]
***Transfusions***
I have transfused many patients that have low H/H's in house. As a resident at a major teaching institution I work along side other young doctors
who actually expect this type of action from us. Needless to say, more often than not, they would like us to take more initiative so we don't bug
them so much on questions they know we know, but feel that stepping on toes might rock the boat. We have to define our boundaries and be
educated on all aspects of medicine.
Our patients expect it, and our colleagues should. Now legally I guess we have to walk the walk if we are going to talk the talk.
Jossy R
[email protected]
EDITOR'S RESPONSE
My recent editorial elicited some opposing responses. It really points to the varied experiences we have as podiatrists. My take on the whole
transfusion situation is this. I've been trained to handle my patients medically, including transfusions, so I'll do what's best for them (especially
if no one else is stepping up to the plate). I'm their advocate as well as their physician. If this gets me in trouble, then so be it. I refuse to practice
medicine afraid to do what's right. I'd rather not practice if that's how it is. One the other hand, I'm not in the habit of burning bridges with other
physicians in my community, so I'm going to do my best to work with other docs as diplomatically as I can to get the best results for my patients.
Jarrod Shapiro, DPM
***Correction to Reimbursement Issue***
Code 26535, which you used for billing the arthroplasty in your recent article, is actually for an arthroplasty of the IPJ of a finger on the hand.
The proper code for arthroplasty on an IPJ of a toe is 28153 although if significant tendon release or MTPJ release is done, then code 28285
is appropriate.
Michael S. Downey, D.P.M., F.A.C.F.A.S.
Chief, Division of Podiatric Surgery
Penn Presbyterian Medical Center
Philadelphia, PA
[email protected]
***Words on Associates***
I read your most recent post and just thought I'd make some generic comments, since I have a lot of experience, both as a past associate, and now,
from an ownership perspective. Our practice currently has 4 partners and the practice generates solid revenues for each of us.
My longstanding partner and I have hired 2 excellent associates, who have since worked their way to partnership status. Allow me to provide some insight
to upcoming graduating residents that I believe will help better position themselves financially and more importantly, from a long term security perspective
as well.
You've raised some excellent points with respect to the effect that declining reimbursement rates create as they apply to newly hired associates.
As a general rule, the immediate post residency completion salaries that new associates wish to command, for the most part, are often generated from
somewhat unrealistic fiscal expectations. What we've generally witnessed is that newly hired associates, often possessing the most advanced surgical
training, often erroneously think that aspect of their resume alone is grounds enough for commanding the impressive salaries they seek. However, if one
stops to realize for a moment, before a patient ever makes it anywhere near an O.R., first, that patient must be added to the practice; a professional rapport
based upon unwavering trust between doctor and patient must be accomplished; and, the doctor needs to effectively communicate, with confidence, what
the patient suffers from and requires, and in such a convincing manner that he/she is willing to undergo the proposed treatment plan. This just doesn't apply
to surgical services, but to all services podiatrists render. Sometimes, this takes time...I still see patients who I've recommended surgery over 10 years ago
and longer...but for various reasons, the timing wasn't quite right...so it becomes critical to plant the appropriate seeds and then nurture those needs by
providing quality, palliative care until such time that the patient has the capability of undergoing the recommended procedure and follow up care. Coming right
out of residency, most young practitioners are quite green with respect to patient interaction and communication skill sets required to translate professional
conversations and recommendations into patient acceptance and compliance. Often, a steep learning curve exists that the experienced owner must be prepared
to encounter with respect to molding that associate's interactive and communication skills to the point where the medically necessary "sell" becomes
second nature.
Furthermore, a newly hired associate cannot just expect to show up for work and "feed" off of the existing patient flow within a practice.
If he or she is truly looking to create a long term security within a successful, existing practice, they need to be prepared to take the necessary steps, as any
practice owner would, in effectively and aggressively marketing themselves to the local community and its various potential referral sources. That means creating
time in one's schedule, which any owner should gladly accommodate, for that individual to get out into the trenches to market themselves. It has always been
about returning to grass roots podiatry. Examples include, but are certainly not limited to: lecturing to local and neighboring senior citizen groups, offering
screenings to the local high school athletic departments, fitness centers, direct marketing to local and neighboring PCP's, lecturing at the local hospital,
interacting with local businesses, chiropractors, physical therapists, etc., etc. The list of potential referral sources within a given community is endless. In addition,
an associate should expect a certain budget be allotted to facilitate their opportunity to externally market themselves to the community i.e.: taking a PCP out to
lunch,etc.
Furthermore, it is the owner's responsibility to internally market a new associate to excite the existing patients to their presence. Assuming an associate is hired
because the volume of patients within the practice is such that the practice is ready to expand, internal marketing can be a very effective strategy to generate
newpatients since the associate's schedule is the one most easily accessible.
A successful associate, one who becomes extremely valuable to a practice is one who not only possesses excellent diagnostic and surgical skills, but one who
effectively markets themselves to generate their own private practice within the existing practice. Any owner, seeing a "go getter" effectively get out
and integrate into the community to create his/her own new patient flow, would gladly accept a short term loss on that associate, as long as the associate
professionally and effectively builds his/her own patient list. That, from an ownership perspective, is the key to success and grounds for advancing that associate
to partnership statusat some future time.
Finally, from the associate side, aspiring associates should look to prioritize what is important in their own lives with respect to where and whom they choose to
associate with. In general, one needs to figure out where one wants to live and potentially raise a family. Seek out successful, thriving, growing practices in
desirable areas that enjoy solid reputations within that community, and, be prepared to bust your butts. If you are open minded, respect the practice management
experience of your new employer, and are willing to learn what it takes to develop a successful practice from scratch, you´ll surely land a position within an
organization that will help create long term security for you and your family...This, I believe, is a heck of a lot more important than what one's first year
compensation package might be.
Best regards,
Barry Mullen, DPM
[email protected]
***Another New Doc's Experience***
Having been in private practice now in Orange County, Ca for 1.5 years now (after completing PM&S 36 in LA) your thoughts ring true for me. After performing
surgery (amputation) on DM2, HTN, Neuropathic patient with osteomyelitis, she developed Stevens-Johnson Syndrome from Levaquin. I followed her sleeplessly,
alongwith myInternist partner for 3 days. ID was also consulted by me. After several days, her labs stabilized, she became afebrile, and appropriate antibiotic
coverage (Clinda/Vanco) was started. Thankfully, she was discharged from Mission Hospital (Mission Viejo) last week I have had several other very difficult HAV
corrections & severe hammertoe arthrodeses 2-4 where toes WOULDN'T pink-up. My favorite "saying" to my extended family of all of my patients
is, "Call me anytime; I don't care if it's 3 AM - Call." My ORIF ankle repairs are easier than these cases! Thanks for sharing your experiences and I look
forward to sharing more of mine.
Renae Witt D.P.M.
[email protected]
***Wound Clinics***
Like you, I'm new [in practice] too. I hated wound care clinic in residency. I don't think I'd do it now. Honestly, I'm not sure it pays all that well either. Facility rates
are a big cut below what we get paid in the office, at least with Medicare in New York.
But you are definitely right about interacting with other providers. I'm busy, but don't really interact much with primary care, unless it's surgical clearance.
I definitely did more interacting as a resident.
Eric Edelman, DPM
[email protected]
***Marketing with a Physician Liaison***
I read with interest your recent "New Doc on the Block" article regarding marketing opportunities for new practitioners. Even though I am 10 years
removed from completion of my residency, I have recently left my director position at Covenant Medical Center in Waterloo IA, and moved about an hour south and
joined forces witha friend in Cedar Rapids. New hospitals, new clinics, new OR staffs, new administrators, you know the routine. One thing every new physician
should check is to see if the local hospitals have a physician liaison as part of their administrative team. This is a person that can set up meet and greets with just
about every clinic in town that generates income in some form or fashion to the hospital. They can make all the calls and coordinate everyone's schedules and
save you a lot of legwork. I have found this to be very helpful as I make new contacts in the worlds of family practice and internal medicine to generate the
referrals. I would recommend that you add the use of a physician liaison to your repertoire of strategies when getting started.
William Knudson, DPM
[email protected]
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