Transition: Resident To New Practitioner
(Starting Your Career)

There are many different things to get your career off the ground once you secure job placement. Some of this can be done before you even start ("Transition: Resident to New Practitioner") in preparation while other items can be done after day one, and some things you should always be doing, especially in the first 3-5 years of practice. Although a new practitioner, I have done a lot in order to build and market myself within my practice to my local community, and have tried to do a lot of background work to help my day go by smoothly while making my patients happy and informed. I have lectured on this topic at the APMA National and to local residency programs, while also writing about it in Podiatry Today. Much of this is not a secret, but common sense things you should not just reflect upon, but actively embrace.

Below are topics and suggestions (of my opinion/ideas) to consider as you start to build your practice. Check out other pages discussing: ​
General Recommendations: 
(discussed in Podiatry Today, August 2016 - Tips on Navigating The "Real World" of Podiatric Practice)
  • Back to the Basics
          > Learn your new EMR; create smart-phrases and templates for commonly treated items.
          > Review common medications you may prescribe. You probably did not write for many topical anti-fungals, steroids, keratolytics, etc in residency, but will in practice. Create a quick go to "med list" for reference. Also, know something about the medications like cure/clear rates for anti-fungals for example (topical Penlac/Jublia vs PO Lamisil).
          > Review ICD and CPT codes and modifiers, and how to appropriate use and combine them. If you can't bill you cant make money (nor will your boss)
  • Establish Protocols
          > Pathology - Consider common pathology you will be treating both office and surgically (e.g, onychomycosis, DM routine care/evaluations, warts, plantar fasciitis, toe fractures, ankle sprains, bunions, ankle fractures, etc) and create a general guideline of treatment. This way at visit 1-2-3, you know exactly what to              do. Some of this may be based on experience, but reviewing common practice guidelines and current literature will assist in formulating your treatment plan.
                --> Good resources include published ACFAS Clinical Guidelines and Foot and Ankle Specialist journal Roundtable Discussions (peer discussions about a topic with treatment recommendations published every few months). Sometimes practices will have a "treatment handbook" to help guide treatments so that each clinician follows a similar pattern which helps with patient treatment if patients see a different physician for follow-up.
                --> Create patient handouts. This can include pathology information for commonly treated issues, protocols for patient self-care (e.g, s/p PNA or wart office procedure); general post-op guidelines;, or referral lists with local physicians information for easy access (e.g. wound care center with location/address, hours, phone numbers, and physicians names). This goes a LONG way in both convenience to you when needed and patients love handouts/instructions.
          > Staff Duties - make sure your assistant knows what you need for various patient presentations whether an injection, dressing change, orthotic casting, prescriptions, or returning patient calls
  • Study Your Geography
​          > Know the local geography - this helps show the patient you are invested in the area/community you are now part of. Know the names of local towns, landmarks, etc, where your office draws from.
​          > Find targets for referral. I found using google maps (orange star = office locations) and searching the terms below and/or looking through your local hospital directory was the  best way to create a list. From this, I created a spreadsheet so that I could (a) send them all a "welcome card" with information about me, (2) keep track of how many referrals they sent (to see if I need to work harder on a target if referral was low), and (3) have a quickly accessible way to get their information to send/fax a "thank you/patient update" letter for any new referral (done the first 2 years of practice).
​                --> Local referral doctors (Primary Care, Family Medicine, MSG, Rheumatology, ID, Orthopaedics, other DPMs, Geriatrics, Pediatrics, PMR, Pain Mangaement, Vascular, Neurology/Physiatry, Clinics); Emergency Rooms and Urgent Cares; Physical Therapy; Schools (MS/HS, Athletic Directors and Athletic Trainers); Lawyers (Personal Injury, Workers Comp, Auto, Malpractice); Nursing Homes, Rehabs, Retirement Communities; Community Programs (local sports clubs, YMCA, Better Business Bureaus, Local Newspaper, etc)
  • Hitting the Pavement
 ​          > Using the list above, go schedule visits (contact office managers) or drop in during lunch (briefly - don't be upset if the doctor is short or doesn't have time for you; you a fellow physician should be most understanding of this), and
                --> Bring: CV, business cards, practice handouts, etc.
                --> Discuss: personal background (connection to the area?); educational background; what do you treat; office locations/days/hours
                --> Know: Office capabilities; insurances you accept
                --> Give: Your cell phone number. Tell the doctor to call/text if they think someone needs to be squeezed in urgently and you will accommodate them.
          > Update your online presence. This includes office website/facebook as well as any profile on Healthgrades, Linked-In, etc.
The A's of Medicine
You will often also read about the 3 or 4 A's of a Medicine.
  • Ability - “Competency comes from being well trained and keeping up-to-date by reading and maintaining board certification.”
  • Accessibility / Availability - “Making the best use of office visits so that problems are discussed in in an unhurried manner and treatment plans carefully developed.”
          > Probably the most important when starting out. You should be at your office from 8a-5p regardless if there is 5 or 15 patients on your schedule (never know who will walk in), giving your cell phone out to local referral bases, staying local during the weekends (ED calls, etc), and accommodate not just your patients but your associates/partners/boss.
  • Affability –“Being likable.” (Not just about whether or not you smile at your patients. It’s about delivering care with empathy)
  • Affordability - Try to keep the cost down and appropriate.

The 2 P’s of a New Practice
  • Persistence: Achieve your goals; Never give in or up
  • Perseverance: “Stuff happens” and you're gong to have to roll with the bumps and bruises along the way. One thing I found helpful was to consider different issues as "P.O.C.’s”, a phrase/concept originally formulated by Dr. Dror Paley in an article about limb lengthening, (and also brachymetatarsia), which I find applicable here. Have some perspective about the issues you may encounter - they all aren't the "worst things in the world" but have varying consequences and side effects. Continue to roll with the punches and push forward to the end you want to reach. 
Other Recommendations:
  • Social Media / Marketing
 ​          > Create (easy to recite/remember) a work email. Keep your personal and work mail separate for organizational purposes.
                --> Update your email signature with office information, hours, website, twitter, etc Use hyperlinks when appropriate.
​ ​          > Update practice website/bio, photo
 ​          >  Twitter? Facebook? Personal Website? LinkedIn? - You may want to venture into one of these tools.
 ​          > Blogging - does your practice have a blog, or should they start one? Local hoispitals often have blogs looking for contributors
 ​          > Local business collaboration - YMCAs (lectures), Running Stores ("Walk W The Doctor" or store educational event), DME stores, etc
  • Building An Online Reputation (reviews)
           > Update online review website (Healthgrades, WebMD, etc) profiles with your up to date practice information (i.e., office location, hours, pathology treated, insurances accepted, etc)
           > "8 Ways to Become a 5-star Physician in Reviews" by Mark Rowh (January 11, 2018 via physicianspractice.com)
           > "Search Engine Optimization: The New Patient Journey" by Melody Gandy-Bohr (February 2018 via Podiatry Management)
​To Read: Collection of articles to read about practice management.