Now that I'm in practice, this broad community is not as available to me. I can imagine that if I were a solo practitioner, it would be even more difficult to foster that community environment. To make matters worse I have very little time to review the copious amounts of medical information available. So, to stay current, I need to maximize my time for medical review. I would caution all residents and new practitioners against becoming complacent and not keeping current with medical knowledge. We all know that physician who never stayed current and is now very limited in his or her scope and quality of practice. Don't become that doctor.

Here's a list of the resources I use most now that I'm in practice.

To review surgical procedures, I use the following:

Chang's Master Techniques in Podiatric Surgery: The Foot and Ankle.

McGlamry's Comprehensive Textbook of Foot and Ankle Surgery

Myerson's Reconstructive Foot and Ankle Surgery

Kitaoka's The Foot and Ankle

For general medical information, I tend to use the Internet more often.  The websites I use most often are:

www.emedicine.com
www.medscape.com
www.merckmedicus.com

For specific podiatry topics review, I like to look at a few sources:

McGlamary
Podiatry Today Magazine
Podiatry Management Magazine
PRESENT Courseware lectures

I know what you're thinking. I work for PRESENT Courseware and I'm advertising their product.  However, to those critics, I would suggest watching a few lectures. Where else can you get concise information about a specific topic in podiatry by a nationally known expert in such a short period of time? What I would love to see are more lecturers about general medicine topics. Of course, if you subscribe to PRESENT Diabetes, you will see quite a number of general medicine topics. It is a highly useful resource with a high yield. I honestly still review the lectures.

I tend to use the magazines to see what new topics, perspectives, and technologies are available. Obviously, I do not take this as gospel. The bottom line, final, absolute source for the most accurate information has to come from the research literature. I still collect journal articles, although the opportunity is now more limited in private practice. Quite often I will question whether a treatment I am providing is the most effective. It is at this time that I refer to the literature. Medicine is moving towards evidence-based treatment, so if you are unfamiliar with this concept, I urge you to become educated.

Here's an example: Achilles insertional tendocalcinosis. This is a very difficult pathology to successfully treat, with often unsatisfactory surgical results. I had found a very interesting article in Podiatry Today regarding Achilles problems which referenced a study highlighting the use of heavy load eccentric calf muscle strengthening exercises (American Journal of Sports Medicine 26(3): 360-366; 1998). I started referring more of my patients to physical therapy with a copy of this article provided for the therapist. I have been seeing very encouraging results, and my patients are very happy as well as pain-free. Our podiatry literature was a portal for further investigation on my part.

What resources do you like to utilize? By no means have I exhausted the potential sources. For instance, I haven’t mentioned the various cadaver courses and conferences available. No doubt, you will choose your own sources of information which best fit your needs. Just remember: keep your eyes open and don't become complacent. Medicine is a lifelong learning pursuit. Best wishes for your next journal club or article review.

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

LETTERS TO THE EDITOR

***Living Below Your Means***

I read your recent "retirement" column with great interest, and I wanted to write to say "well done," particularly the repeated message of living below one's means.

Many years ago, I was assisting families who wanted to move from two incomes to one so that mom or dad could spend more time with their kids. What I discovered after running countless budget numbers was that most of these families had the money but they were spending it on the wrong things. Lots of “toys” and meals out and vacations that were too lavish.

Now, as I counsel physicians on growing their practices, I find that most of them were not taught the business and financial lessons in medical school that they need to operate a practice in the black.

I have recommended the book "Your Money or Your Life" (Joe Dominguez & Vicki Ruiz--it was on the New York Times Bestseller list for a very long time) to many people as it describes in detail the traps into which many American families fall. But it also makes recommendations. (No, I do not have an interest in the sales, it's just a good book). Again, good column.

Sincerely,
Steve Smith Vice President,
Practice Builders
www.practicebuilders.com
(800) 679-1200 x2012

 ***Young Looking Doc***

I enjoy the New Docs on the Block, I know it probably takes a lot of effort to put that together consistently. Anyway, I thought a topic could be (and maybe I'm the only one who gets this) is how it seems every other patient either asks me how old I am or tells me that I look way too young to be a doctor. I only got asked about five times yesterday, which was a good day :) It doesn't bother me that they want to know, and usually don't do it in a mean spirited fashion, but I think it takes time away from them in treating their problem! That, and the older I get I really don't like to tell my age!

Megan Lawton, DPM
[email protected]

EDITOR'S RESPONSE

Thank you for your kind words. It does take quite some effort to put this editorial together, not just on my part but the entire PRESENT team. If I can provide a useful resource to the podiatry community, then it is well worth my time. In fact, I have come upon this issue as well. Apparently, I appear younger than my chronological age. My father thinks I look like I'm 12 years old!

I have, in fact, been considering this topic for one of my editorials. My idea was to have gray highlights placed in my hair and see if I still received as many "complements" about my age as I do now. When I actually begin this experiment, I planned to take before and after pictures, so that our reading community can see if there is, in fact, a difference. The bottom line is, though, if you are well-trained and competent, I don't think it should matter how old you are. My response to people who ask me about this is to reply in a friendly manner, "when I'm 60 I will look 40 years old!"

-- Jarrod Shapiro, DPM

 ***Hospital Privileges***

I enjoy reading the forum 'letters to the editor', as well as your responses. Thank you very much for your time and consideration put into these topics. As a 1st-yr resident, they are invaluable and tremendously appreciated.

Along those same lines, I would like to submit a topic for discussion. Looking ahead to when one's residency training is completed, what seems to be the typical scenario for someone who's seeking hospital privileges in solo practice? Specifically, I'm assuming most hospital staffed podiatrists deny many of their colleagues' requests to become so, thus, keeping an upper hand. This behavior seems to be more prevalent in the higher populated areas, in which most desire to live. Thereupon, what's the next step for a new podiatrist who has been denied hospital privileges, but is required to be on staff for practice and insurance reasons?

Thank you for your time.

Zacharia Facaros, DPM
[email protected]

EDITOR'S RESPONSE

Great topic for discussion. I find it interesting you assume other podiatrists will attempt to block other new docs from hospital privileges. Is it so common in the country that our new first year resident colleagues think it's the norm? If so then that's very sad for our profession. I have seen incidents of this as a resident, but as a new doc in practice, I've actually had nothing but good experiences from the podiatric community. I have, though, been blocked by ortho at one of the three hospitals I work at. For the most part though, podiatrists and orthopedists have been very supportive. I'd like to hear from the rest of the podiatry community regarding this issue. A true dialogue may be very educational for all of us.

Now, I'm no expert on hospital privileges but, if you have the training and surgical documentation, a hospital does not have a leg to stand on legally speaking. I saw a lecture by the APMA a couple of years ago regarding this issue, and they seemed willing to help, although it does sound like an uphill battle in those cases where there is real opposition. What does the rest of the reading community feel about this issue?

-- Jarrod Shapiro, DPM