I'm going to present topics we discussed when I first began this series 123 issues ago when we were Residency Rap. I think this exercise will provide new physicians as well as residents an interesting perspective on the practice of medicine.

Granted I've only been in practice 2 ½ years - how much can have happened in that time? However, I'd argue the first 5 years or so of practice is a volatile time of change. Reflecting on that change will, hopefully, provide our community a useful insight into what some new docs may expect. I'd also like to offer anyone in the community, regardless of practice years, to write in with their reflections on how their practice life has changed since they began practice.

In general, my last 2 ½ years have been quite full of successes, failures, significant changes, and new opportunities. I’ve started practice, opened a satellite office, worked in a wound care clinic, changed to a second type of practice, moved across the country, gained some gray hairs (and a couple of worry wrinkles), and seen the early evolution of my practice.

Here are a few general trends I've noticed over my early practice years. We'll discuss some of these in future editorials:

• I see predominantly adults with little exposure to pediatric disease with a smattering of trauma and an average amount of biomechanics thrown in (the average podiatric practice).
• Diabetics are a significant component of my patient population – and growing.
• I enjoy surgery more each year with a very slight diminution of perioperative anxiety (about complications) each time I do a case.
• I perform more forefoot and midfoot surgery than rearfoot.
• I’m not yet board certified, although I have many more cases than necessary to be certified in foot surgery (not enough for rearfoot reconstruction and ankle).
• Insurance and the growing paperwork reduce the overall satisfaction of being a physician.
• Reimbursement remains generally poor for the amount of effort I put into my patients.
• I worry often about lawsuits and am very cautious in how I deal with patients (specifically surgical patients).
• I’ve made increasing income for each year in practice.
• On a personal standpoint, I have more time now for family and interests than I did as a resident.

Overall, my practice experience is positive.  I find the medical/scientific aspect of podiatry fascinating while the insurance/paperwork aspect very frustrating.  I enjoy the patient contact, while I’m not a fan of the intra-physician politics.  Marketing a new practice, although monumentally important, can be very difficult and often frustrating.  I would still recommend podiatry as a specialty and medicine in general as a profession.   I’m very optimistic about my personal future as a new doc and podiatry’s future in general.  I look forward to further reflections on the past and future.  Best wishes and happy holidays. Write in with your impressions.