Becoming Involved in the Podiatric Profession

By: Corrine E. Renne Landau, DPM

Have you ever thought about getting involved in the profession after residency? You may think that you won’t have the time, be overwhelmed, or that it may be difficult to seek out opportunities, but it is very easy. A great place to start is becoming involved with your local component as well as your state society. It is crucial to the betterment of the profession and to yourself to become involved with these organizations and there are many benefits as a respected member.

How does this benefit me? This is a question you may be asking. As a young member of the profession, you have access to many resources through these societies, and the opportunities are endless. APMA’s Young Members Institute contains great information on starting a practice, retirement planning, insurance information, special training and discounted programs and plans.  Many state societies, for example in New York, also have resources available to young members that are easily accessible via the internet.

How did I get involved?

I started as a student. I served as a student liaison to the American Association of Women Podiatrists (AAWP) and I attended their conferences. From there I started to work with college recruitment forming alliances through NYCPM and was a student ambassador for the American Diabetes Association (ADA). I was also involved in student council, and other school committees. After graduation from residency we were urged by our director to become members of our state society and the APMA. I started to attend my local chapter meetings which provided monthly updates on the state and national level and from the Insurance and Legislative Committees.  I became comfortable to ask questions and get involved in discussions at the meetings. After attending, I not only gained knowledge but also met many kind and welcoming people, including residents from other programs.

Now that I was feeling a little more at ease, the time came where I was asked to run for the editor position of our Executive Board. This as you could imagine was a little nerve racking for me, but I ran and am happy to say won that election. From there I worked my way up from Editor to Secretary and then Treasurer, to Vice President and then finally to President. I served as the President to NYSPMA Kings division for two years. During that time, I also encouraged many young members to get involved and am proud that we currently have two residents on our executive board today. I have also become involved on the state level serving on many committees. This broadened my professional network. I am happy to say that I have many friends and colleagues because of my involvement and have made great friendships within our profession.

Today, I am in private practice and happily have students and residents shadowing frequently. I remain active with the local hospital residency program. I enjoy teaching and helping the youth of our profession. I am also a proud diplomate to the American Board of Podiatric Medicine, and have started involvement through this organization.

So how do you become involved?

Get involved through your residency. Next get involved locally in your state chapter and finally APMA. You can contact these organizations directly to ask about their Young Members Institute and what they offer. You can ask where the next local meeting is and attend. You can sign up for free to be a member as a resident (or student) of both your state and APMA. Many meetings are listed on the organization’s websites.

Once you become involved locally you may want to take the next step and get involved with being published or perform case studies for one of the many journals or conferences. There are many opportunities in academia. There are various contests and publications that are looking for submissions. PM news often has contests for young members to submit writing samples for prizes and publication. You can contact your local school or residency program or the various publications directly as well.

You can also get involved with the certifying boards. The American Board of Podiatric Medicine has many options for young members to become involved. There is also a lot of useful information on their website, their APP, and their social media platforms.

As you can see there are various opportunities to become involved from social to professional and academic. Now what is the benefit? The first benefit is information. This is the best way to stay up to date within the profession. You can achieve this by attending local meetings and reading the various newsletters and publications. The second benefit is discounts. Depending on where you practice there are many discounts that you can have through the APMA, various state boards and many academic boards. There are discounts on everything from travel to insurance and everything in between. Please contact each organization directly. The third benefit is help. Help is important. Often we have a question about an insurance company or protocol and having a person to ask is priceless. Or one may have a question about where to order a product or medication? Or how to start your own business? Or how to sign a contract? Or how to get on staff at a hospital or surgical center? All these questions and many more have been addressed through the APMA and the state local boards as well as the Young Member Institute. In New York we have a coding and insurance portal where we can ask questions and its very helpful. Lastly, another benefit is continuing education credits. In order to keep our licenses active, we must attend various educational forums for CMEs. Why sit alone online when you could attend one of the many local conferences and get to know some of your colleagues while having hands on training? Meet your colleagues and earn credits to keep your license active.

I have been a practicing Podiatrist for the past 13 years. I am happy to be involved and happy to have so many colleagues that I consider friends and family. I am helping to keep our profession topnotch and I am determined to help the young members. The young members are the future of our profession and it is crucial that they remain involved and in the forefront of the profession.

In closing, I urge you to get involved in some form or another. Whatever your interest or your passion there is a way to become more involved. Step up to become a leader for podiatry! Everyone is welcome to become involved and make the most out of your career. Please don’t hesitate and become involved today. You will be happy that you did, and our profession will be better for it.

 

 

Recommending the Proper Running Shoes

By Vinay Matai, DPM

With so many brands and styles of running shoes, recommending the correct one can be challenging and overwhelming. We can choose to refer the patient to a local running store or as podiatrists use our knowledge to educate him/her on choosing the proper footwear.

First, the patient needs to understand how complex the foot structure really is: 26 bones (28 with sesamoids), 33 joints and over 100 ligaments. As Leonardo DaVinci stated, “the human foot is a biomechanical masterpiece.”  Understanding the patient’s biomechanics are crucial in choosing the right shoe. A complete exam including a biomechanical exam and asking the patient specific questions will help determine the best type of shoe. Here are a few examples of questions you may ask to better understand your patient’s needs.

What type of activities do you plan on using the shoe for? Walking, running, high intensity interval training (HIIT), trail/mountain walking, or simply for standing up at work.

What is the most important feature of the shoe? The patient’s response is usually one of style, comfort, or support.

How old are your current shoes? Look at the treads of the shoe. Remember, the life of a shoe is approximately 300-500-mile range, but factors such as body weight and type of activity may affect the livelihood. Examining shoe wear and tear can tell if it’s expired.

What is your budget? This question can be sensitive and difficult to ask. To circumvent this, notice the patient’s shoes during the encounter. The brand and style can tell us price points without necessitating the question. Their shoes tell a story- the type of work they do or their buying pattern.

What shoe brands do you usually purchase? Brand loyalty is very important with millennials and even Generation X. This is important because if they are loyal to checks or stripes (Nike or Adidas), then you are going to want to suggest something that’s in-line with their psyche, or be prepared to spend a little more time convincing them that the brand they’ve been wearing for years will no longer meet their biomechanical needs.

Are you a runner? What are your speed goals? Will the shoe be used for distance running or sprinting? Is the patient training for a 5k or a half marathon? The weight of a shoe can affect race times- the heavier the shoe the slower the time.

Now that we’ve gained additional information, we must educate our patients on the types of running shoes and parts of a shoe. There are 3 main categories when it comes to athletic shoes: neutral, stability and motion control.  There are however a few more specialized categories such as minimalist, zero-gravity shoes, rocker bottom, track or trail shoes.

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Neutral:  Neutral shoes are great for a person with a normal or medium arch height. They can also work for mild pronators. Neutral shoes do not guide the foot, rather they allow the foot to move naturally within the shoe. The design is usually absent of a stabilizing frame or medial post.  One thing that varies among neutral shoes is the amount of cushioning and the weight of the shoe. Some people prefer a high cushion shoe while some may prefer a lower profile shoe with minimal cushioning. Notable examples of neutral shoes are the Nike Pegasus, Brooks Ghost, Asics Cumulus and a high cushion option is the Hoka Bondi.

Stability: Stability shoes are made with stability features such as a medial post or a stiffer material through the midsole. They often include guide rails which control side-to-side motion. This type of shoe is great for those with mild to moderate pronation or someone with normal to low arch height.  These shoes are more rigid than neutral shoes but not as rigid as a motion control shoe. Notable examples of stability shoes are New Balance 860v9, On Cloudflyer, Saucony Guide ISO 2, Nike Zoom Structure 22, Asics GT2000, Brooks Adrenaline GTS 19, and Hoka One One Arahi

Motion Control: Motion control shoes provide the most stability. If you have a patient with a symptomatic flat foot with a flexible deformity, this style should be recommended. Warning! These shoes can only be found in your specialty running store. Motion control shoes are for your mild to severe pronators and usually have a firm post that reinforces the arch, stiffer heels and a designed to counter overpronation. Often times shoe companies have a proprietary component that enhances their arch, for example  Hoka One One’s J-FRAME™ adds support by using a firmer density foam on the medial side all the way to the front of the shoe and extending back on the heel’s lateral side. Notable examples of motion control shoes are. Hoka One One Gaviota, ASICS GEL-Kayano, Brooks Addiction, and Saucony Omni

With these helpful tips, you can now speak with confidence in recommending brands or styles of shoes. I do recommend visiting local running stores and building relationships with their staff. Often you can pass discounts from running stores to your patients with your referral. Your local running store is also a great place to give small presentations and get to know local runners. It is a great opportunity to build your brand and market yourself for free.

A Surgeon’s Perspective on the Value of ABPM Certification

By: Stephanie Hook, DPM

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Everywhere you turn, people have their opinions and thoughts on what your future should hold.  Surely, your peers, residency director, attendings, friends and family all have your best interests in mind.  All this input can become overwhelming and cause decision-making to become more difficult.  You already must decide if you will specialize within podiatry, where you want to live, if you want to join a group or be a solo practitioner, and so much more.  On top of all of that, deciding which board examination to take can cause your head to be left absolutely spinning.

When I started residency, before three-year programs were the norm, I did not want to be a surgeon.  I matched in a two-year program at Catholic Health System/Sisters of Charity Hospital in Buffalo, New York.  I was excited to start my career journey at a program that was well recognized and accepted within the hospital.  I loved everything I was doing and could not wait to get into my own office and start helping patients.  I loved the “routine” care.  I even often stated that one of the things I loved most was when patients came in, I could treat them, and send them home feeling better.  Personally, I think seeing how you were able to help someone immediately was gratifying.  I thought that was the ideal career path for me.

Becoming a Surgeon

Imagine my surprise when, within one week of surgery rotation, I was hooked.  I knew I needed to be a surgeon. I don’t recall exactly when, but early in my residency, my director asked if I would be interested in completing a third year.  I jumped at the chance to get even more surgical exposure and training.  I then completed my three-year residency, learning surgery from podiatric and orthopedic attending physicians.

After completing my residency, I joined a podiatric practice in Central New York.  At the time, there were eight podiatrists within the group that covered eleven offices in the greater Syracuse area.  My practice picked up quickly and I worked hard building my practice and my reputation.  Within a couple of months in practice, my surgical volume soared.  I was doing cases as often as I wanted, but still spending many hours a week in the office.  It was the perfect balance for me.  This was the life I was meant to have.  As my time in the group continued, I became a part of four area hospitals and also began volunteering on some New York State Podiatric Medical Association committees.   Eight years into practice, I had wonderful patients, loved my job, and loved my life.

How could it get any better from there?  Three years ago, I was asked to join an orthopedic practice.  I am part of an extremely large group, again in the greater Syracuse area.  While they were originally looking to hire a non-surgical podiatrist, I asked for that to change.  I had performed surgery for eight years while building my reputation and patient relationships and didn’t want to sacrifice my current state of practice.  I dramatically increased the number of patients seen every week in this new group, and I am an appreciated colleague in an amazing company.  The support I have is so meaningful.  It allows me to grow as a podiatrist, but also gives me the opportunity to spread my wings.  Since joining my company, I have kept my same surgical volume, increased my office visits, and have still had time to become more involved.  I am now able to serve our great profession as a Trustee of the New York State Podiatric Medical Association, the Chair of the Public Education and Information Committee of the NYSPMA, and as the Student Chapter Coordinator of the American Association for Women Podiatrists.  I also serve the ABPM as a Membership Committee Sub-Chair, working with Crisis Communication and Audit Committee.  I still am affiliated with four hospitals and now also serve as the Podiatry Division Chief at Upstate Medical University Community Campus.  In my thirteenth year of practice since graduating residency, I have shaped my career to be exactly what I have hoped it could be.

One thing I have not mentioned yet is that I am single-boarded.  To keep this story as honest and forthcoming as possible, I originally decided to take a single board because I have test-taking anxiety.  The decision of which board to take was extremely simple for me.  When reviewing both boards, I found the American Board of Podiatric Medicine certification to be more comprehensive.  Just because surgery isn’t in the name does not mean that it is excluded from the certification.  I also examined what the boards are doing to help further our profession.  I have personally witnessed the ABPM work tirelessly to promote its members and our profession, which is yet another value I receive with my certification.

The Value of ABPM Certification

I believe my ABPM certification to be better for me as it is all-inclusive.  I also find that it is a more understandable and recognizable name for my patients.  There will be plenty of patients who will be dead set against the idea of surgery. There are, of course, plenty who do desire surgery.  I believe that the simple statement “Certified by the American Board of Podiatric Medicine” conveys to both of these patients that I am accomplished and recognized in my field- which is podiatry.  All podiatry.  In the years since achieving my ABPM certification, I have tossed around the idea of sitting for my surgical boards but have elected not to do so.  I have seen no negative impact on myself, my career, or my patients from my decision.

At the end of the day, you have to do what is best for you.  I can tell you that I would not change my choices.  I am proud to be a Diplomate of the American Board of Podiatric Medicine.  As I stated earlier, I am simply sharing my story so you can see how your choices are simply that- YOUR choices.  Choose the board(s) that make sense for you, your career, and your patients.

 

 

Announcing the Passing of ABPM Director, Dr. Stephen M. Geller

Stephen M. Geller, DPM

The Board of Directors and Staff of the American Board of Podiatric Medicine are heartbroken to announce the passing of Director Steve Geller, DPM, aged 54. Steve passed away on Tuesday, March 10, 2020. He died of complications of a massive CVA.

Steve has had many leadership roles with the ABPM, most notably as a Director and as Chair of the Examination Committee. Under Steve’s purview, the examination committee has evolved into a state of the art process which provides real data back to residency programs as they educate and train our future colleagues. Steve has also been instrumental in ABPM’s efforts to continue to value, educate, and employ biomechanical examinations within our residency training. Steve also worked diligently on a national level serving both on the CREC and other CPME committees.

Dr. Geller’s life is an exceptional example for so many to emulate as he worked with hundreds of residents and students as a leader in their education process. He was recently appointed the Chief of Podiatry at the Carl T. Hayden Veteran’s Administration Hospital in Phoenix, AZ and will be sorely missed by the staff and veterans he served.

Words cannot express our grief and loss of our dear colleague and friend. Our hearts go out to his beloved wife, Ellen as well as Steve’s children Ryan, Alli, and Sam and Ellen’s children Kelsey and Carter.

A Celebration of Life will be held for Steve at the ABPM Annual Meeting of Members in July in Boston, MA. More details regarding this event to follow.

ABPM Coronavirus (COVID-19) Travel Guidance

ABPM Restricts Travel amid Coronavirus Outbreak

The rapid spread of the novel coronavirus (COVID-19) overseas and in the United States has raised the threat of a global pandemic.

Effective immediately, the American Board of Podiatric Medicine (ABPM) has restricted all international and domestic travel in light of the COVID-19 outbreak. It is our responsibility to ensure we are protecting the health and well-being of our patients, the public, our employees, board members, and volunteers.

While government agencies are not yet advising restrictions to domestic travel, the ABPM joins a growing list of companies, healthcare organizations, and universities taking precautions to prevent the spread of COVID-19 and to prevent displacement of those traveling on behalf of the Board.

ABPM has created the following travel guidance that will be in effect at least through September 30, 2020. These are subject to change based on any new information we receive and we will keep you informed as needed.

We advise you to use your best judgement to protect yourself, your coworkers, your family, and members of the community.

Board-related Travel

  • International destinations: Starting today, we are instituting an international Board travel restriction to any international destination. You are strongly encouraged not to book any future travel to any international destinations until the safety of such travel becomes clear.
  • Domestic destinations: You are strongly encouraged to restrict travel within the US for only essential, business-related purposes. Should a specific event be considered essential business travel, you must first receive approval from President or Executive Director before traveling or booking travel.

The Board will maintain normal business hours in California. In the event that a “work from home policy” has to be enacted for employees, the board shall continue to conduct business as usual.

UNDERSTANDING YOUR MEMBERSHIP FEES

Annual Membership Dues vs. Maintenance of Certification (MOC)

Periodically Headquarters is queried by members regarding the annual requirement for registration fees (dues), and Maintenance of Certification (MOC) fees.  While this topic has been addressed in prior newsletters, as new diplomates are brought in annually, it’s timely to cover it once again.

The ABPM Annual Membership Dues and Maintenance of Certification (MOC) are two separate fees. Upon achieving either Board Qualification or Board Certification ABPM members are required to pay an annual re-registration fee (dues). After becoming Board certified with ABPM, all Diplomates are required to enroll into the MOC program the following year as the form of re-credentialing through a 10-year cycle. The MOC program is in place to enhance your certification credential through the process of lifelong learning (versus taking a high stakes examination every 10 years to recertify). MOC fees cover the costs of developing, providing and administering MOC activities that promote lifelong learning with self-assessment and quality improvement

What are Annual Membership Dues used for?

Although the Board’s primary functions are conducting national examinations in the specialty of podiatric orthopedics and podiatric medicine and evaluating the ongoing competency of its membership, there are other tasks in which the Board is involved to provide prudent stewardship of the organization and preserve the value of the diplomates’ certificates. Our profession’s size and internal structure compel the major entities associated with it to be involved in other areas essential to the profession’s growth and ongoing success. The ABPM has both a direct responsibility to its members and an indirect responsibility through its input on various national committees working toward the betterment of the profession as a whole. What follows, while not comprehensive, should give the membership insight and perspective on the activities of the ABPM, and the relevance of the member’s ongoing financial responsibility with the organization.

The Board of Directors holds three face-to-face meetings per year that are convened approximately four months apart. These are supplemented by periodic conference calls. All are required to monitor the ongoing administration of the organization, review board policy, engage in strategic planning, receive reports, assess effectiveness of standing and ad hoc committees, etc.

The Budget/Audit Committee works closely with headquarters in determining the annual budget, fore-casting future budgetary requirements and personnel needs, reviewing monthly financial reports, etc.

The Bylaws Committee periodically reviews both the policy manual and bylaws to ensure that new and updated programs and actions are consistent with the language and spirit of those documents.  Periodically recommendations for specified bylaws modifications are brought to the membership for a vote.

The Credentials Committee is charged with evaluating state actions brought against members that impact their licensure, as well as current or former member appeals (e.g. reinstatement, change in member status, etc.).  It also monitors compliance with board policies (e.g. advertising, ethics, etc.)

The Examination Committee has four subcommittees: Certification, Qualification, In-training and the CAQ. They develop new items for the respective examinations, review and update established items, review and update reference and study guide material, interact with the Board’s psychometrist in assessing and developing current and future testing methodology and evaluate the examination blueprint relative to current diplomate practice.

The Marketing Committee is tasked with disseminating relevant information to the membership both on the web site and via e-mail, developing resident and diplomate newsletters, developing tools for use by the membership in connection with insurance panel and hospital activities, developing informational materials for distribution at the ABPM booth at regional and national conferences, etc.

The MOC Committee has been most recently working together on restructuring the existing MOC process that has been in place since 2011 after replacing a costly recertification exam. The committee is working collaboratively with both ACPM and PRESENT Podiatry to improve the process and allow members to maintain certification by completing valuable educational activities online among other required components.

The Nominations Committee reviews curricula vitae and existing committee member activity so as to make recommendations for future directors to the Board.  The Nominating Committee also assists with the candidate slate ultimately presented to the diplomates for election.

The Speaker’s Bureau, while not a committee, provides a presence proactively and at the request of the colleges of podiatric medicine and residency consortia to convey relevant information about board certification in general and ABPM certification in particular. Often the Speakers Bureau personnel also deliver clinical content in a specific area, or areas, of expertise.

 

Clinical Presentation Skills: Avoiding Burnout as a Resident and/or Young Physician

by Priya Parthasarathy, DPM

I’ve seen it happen from my earliest days of residency- exceptional physicians with or without family obligations who struggle to cope with the constant demand of being a physician. But the statistics are staggering.

According to the American Medical Association (AMA) more than 40 percent of physicians are experiencing at least one sign of burnout and physicians suffer burnout 2 times more than other US professionals. In a 2014 survey of 504 medical residents at the University of North Carolina, 70 percent met criteria for burnout based on the Maslach Burnout Inventory, a common tool used to assess burnout.

The consequences of physician burnout are serious and wide-ranging. From poor job performance to—in the most extreme cases—medical error and clinician suicide. This piece will focus on a subset of the profession—residents and young physicians.

What is burnout?

Physician burnout is defined as a “syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work,” according to Shalafelt et al in the American Journal of Medicine.

It differs from depression because it primarily affects an individual’s relationship to one’s work and it most frequently occurs in people whose work requires an intense involvement with people – physicians, nurses, social workers, and teachers. Challenging circumstances at work are likely to spill over into one’s personal life. It is difficult to keep one’s professional and personal life separate.

Why does it affect Young Physicians and Residents?

Though young physicians and residents have only been in practice for a few years, they are still susceptible to burnout. It is certainly not an overnight change, but overtime, through an accumulation of factors. Physicians can burn out at any stage of their career due to endless documentation requirements, long hours, emotional strain of cases, and patient frustrations from lack of knowledge about their insurance providers. Recently, the new age of patient satisfaction surveys may lead to the practice of overtreatment. Physicians can burn out at any stage of their career. The triggers can be endless, but it is important the individual and the industry find ways to cope.

What are the symptoms of burn out?

Symptoms are different for everyone, but the literature outline’s exhaustion, cynicism, and becoming emotionally detached from patients as the most prevalent signs.

Lack of enthusiasm or motivation for work, frustration, passivity, detachment, reduced efficacy, behavioral extremes, mistakes, compassion fatigue, insomnia, depression and health issues are other symptoms described.

How does it happen?

The AMA highlights 7 scenarios which may put you at risk for burnout.

1. You have a high tolerance to stress.
2. Your practice is exceptionally chaotic.
3. You don’t agree with your boss’ values or leadership.
4. You are the emotional buffer.
5. Your job constantly interferes with family events.
6. You lack control over your work schedule and free time.
7. You don’t take care of yourself

As young doctors, it is important to consider these factors when choosing your place of work or next steps in your career. Yes, it may be impossible to check all these boxes off as you may focus more on salary, benefits and patient volume. Your well-being should be high on the list as well.

Coping mechanisms

Your mental health is important. Here are a few coping mechanisms that can help you avoid burnout.

1. Take your vacation

There are many reasons you may choose not to take a vacation, especially in your first few years out of practice. You may feel guilty because you are the “new hire,” or your place of work may have the attitude that vacation is a luxury. Common sentiments are, “I did not take a vacation for years when building my practice,” or “I have never taken a 2-week vacation.” These should not determine whether you take a vacation or not.

Personally, I am guilty of limiting my vacation. Being percentage based, when I do not work, I do not get paid. Nevertheless, this is not a reason to not take my deserved vacation. My husband and I feel that we overstress about our patients and the office on vacation. However, we have to learn to maintain a positive attitude and not think about work so much when we are away. As my acupuncturist (yes, I see an acupuncturist) says, “we treat our bodies like ATMs, we take and take and take but never deposit.” Think of vacation as paying yourself back for all the hard work that you do.

2. Exercise

Exercise is a common stress reliever for many people. It can be especially useful in coping with physician burnout. Working exercise into your day can be as easy as a 10-minute walk at lunch (if you get one) or building in efficient workouts such as HIIT (High Intensity Interval Training) into your schedule. If you continually neglect yourself, you may neglect your patients too. My husband and I have invested in a Peloton so we can jump on the bike for even 15-20 min. We found it is a great stress reliever and so time efficient.

3. Say “NO” more often

When I first started practice, I thought I had to say yes to everyone and everything. I did not want to be known as the lazy new associate as I was building my practice. I slowly began to realize that it is important to slow down and I don’t have to take on every case. It is crucial to set limits for yourself and respect your boundaries. It is important to remember that you don’t have to prove yourself to anyone.

4. Live within your means

This is a big one. Especially after you graduate residency, doctors are frequently expected to have the nice cars and big homes. We make the big bucks, right?
Reducing your monthly expenses will reduce the pressure on you to earn more income.
By reducing your spending, you will have less urgency to work to make money.
Furthermore, when you reduce your spending you may be able to cut down your work hours.

5. Find a place where you are happy

This one is particularly tricky to identify but necessary to prevent burnout. Whether you are at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane.

6. Spend time with your family and loved ones

It is important to build and maintain connections with your family and friends. It is so easy to get caught up in the medicine or upper middle-class bubble. It may change your outlook on life.

7. Share and learn from other physicians

This is especially important in residency. You have an endless network of physicians to talk to about their work and their lives. Learn through their experiences. Attendings can discuss what fulfills them and how they handle fear and failure. We often talk about revisional surgeries and how to deal with complications, but we don’t discuss the effects it has on us mentally. It is important to hear how others deal with challenging situations. Promoting wellness in physician trainees is key to preventing burnout.

8. Therapy

We head to the Doctor, Dentist, Optometrist annually for a checkup. What about a mental health check? We often neglect the part of the body we use the most, our brains! Scheduling periodic mental health checks and finding a therapist you can turn to before you need one is a good proactive approach.

Resources

There are many resources available to you.

The APMA has a well-being index on their website. The “Well-Being Index” is a quick, confidential survey from the Mayo Clinic to access your own well-being and see how you compare with your peers. There are also many articles and resources on physician wellness. This is a free resource available to members.

https://www.apma.org/wellbeing

The AMA’s STEPS Forward™ open-access platform offers innovative strategies that allow physicians and their staff to thrive in the new health care environment.

https://www.ama-assn.org/topics/physician-burnout

Final thoughts

It is important to remember that we are both physicians and human beings. There will be nights that we will not be able to sleep worrying about a patient or a surgical outcome and that is ok because we are human. It is important to find your own method of separating your work and personal life. This is particularly challenging for those of you in residency. While residency can be a time of frequent self-doubt and feeling underappreciated, it is important to remember that your patients look to you for guidance as a doctor and you have earned that privilege.

It is also important to remember that the onus is not only on us as doctors but also on the health care community to work on solutions to this complex problem. My goal was to shed light on this very important topic and provide strategies that you can implement now, early in your career.

Clinical Presentation Skills: How to be a Stand Out Applicant for Employment

PGY-3 Year…Freedom at Last! Right? 

How to be a stand out applicant for employment

By: Jonathan D. Rouse, DPM, DABPM

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Your phone goes off in the middle of the night. You pop up immediately because you are a PGY-3 and you’re used to this lifestyle now. You’re just happy it’s not a pager going off…until you see it’s your junior PGY-1 calling. You pick up and they ask you how to order a medication in the EMR. Of course you’re happy to help because you are nice and empathetic. You get it; you were once a PGY-1 trying to figure out how the heck to input orders in the system.

We’ve all been in the trenches. The first day of residency, wide-eyed, scared and asking ourselves, “What did I get myself into?!” Then second year comes and you’re so used to the smell of wounds that you can probably eat lunch while treating them, although unsanitary and not recommended. By the end of your PGY-2 year, your confidence level is usually beginning to peak. Your PGY-3 year starts, and the feeling of being near the top of the food chain is ephemeral as you realize that you soon need to find a real job while still completing your training. While nothing can replace great training and confidence, there are some preparations that can aid you in standing out against other applicants.

Curriculum Vitae (CV)

The CV is a living breathing document. I personally view it as a professional diary as it shows everything that you have done in relation to your professional life. It’s hard to fill up during residency because you are so busy training, but it should be updated at least quarterly. Once in your PGY-3 year, it should be updated monthly. I recommend keeping a list on your phone of information to add, then once the time comes, you aren’t struggling to remember information. Also, when saving the file, I recommend putting the date last updated on the file so you are aware of the last time you made updates. Everything you do, whether it be workshops, cadaver labs, research, specialized trainings, published journal articles, pending journal articles, poster presentations, etc., needs to be on your CV. The bullet points should be quick and to the point, however, elaborating on your residency training is a good idea so as to not undersell or oversell yourself when the time comes to apply for employment.

Your CV is also a reflection of your organizational skills. It should have a natural flow and be separated into different headings such as: Education, Professional Training, Work Experience, Research Experience, etc. It should also be chronological within each sub-heading. The job you’re applying for may have 30+ applicants depending on the position; if the reviewer has to jump all over your CV to try to figure it out, it’s going in the trash. Proofread, proofread, and then proofread again. Then have your parents, spouse, best friend, whomever proofread it again.

Your professional references are also very important, so ensure you are selecting people that can speak positively about your professional and clinical skills. The interviewer(s) will more than likely contact your references to learn more about you as they will only get to know a little bit about you in your interview.

Cover Letter / Letter of Intent

A Cover Letter or Letter of Intent should be supplied with every employment opportunity you apply for along with your CV. Before applying, do your research so you can explain why you think you would fit into that particular practice / hospital. Explain how you think you can help the practice / hospital become successful with your skill set. This is a chance for you to sell yourself, so make it count! Again, proofread, proofread, proofread.

One of your best resources is the product reps in the area you are looking to work. They will know about job openings, personalities or different doctors, which surgical centers have the best food in the doctor’s lounge, etc. They are at your disposal and are full of information that can aid you. Nothing will make you look better than going into an interview and knowing nearly everything about someone’s practice or hospital. Just act surprised when they tell you they have Surf and Turf daily in the Doctors’ Lounge! (Do these even exist anymore)?

Logs

Once you meet the minimum required number for surgical procedures, biomechanicals, H&Ps, etc., you should stop logging right? WRONG! I believe you should try to log all encounters in residency. Perform a nail avulsion? Debride and perform cryoablation on verrucae? Put on an Ex-Fix (This is not a stand-alone surgical procedure)? Debride a wound and place a bioalternative? These should all be logged as category 6, (Other Podiatric Procedures).

Put a detailed explanation in the Notes on PRR when logged and you have a diary from residency. Your numbers matter! Imagine the strength of a cover letter with sentences such as: “Extremely comfortable in the clinic setting as well as the Operating Room; 10,000+ patients seen in clinic while performing over 800 surgical cases in Residency.”

Or if you happen to be applying to a Wound Care Center part time: “5,000+ patients seen in residency with greater than 25% of them obtaining bioalternative products to aid in healing. Comfortable managing complicated wounds and extremely knowledgeable about the different treatment modalities.”  Statements such as these will set you apart from other candidates as they may not have the data to support why they should be hired over you.

It’s great to be able to have data when interviewing. What if a practice is looking to expand and needs a Podiatrist with RRA experience? You have all of your rearfoot cases, but if logged correctly, you can pull out how many External Fixators, Delta Frames, etc completed in residency. If you can send prospective employers your logs or be able to pull data from them when they inquire about certain skill sets, you will stand out as the numbers speak for themselves.

Be Realistic

Every Doc thinks they deserve to make $1 million per year out of residency. The dues have been paid and now it’s time to get paid the big bucks! But guess what? You will likely be offered a lower salary than you were hoping for, especially if you are entering a practice system versus a hospital system. The reason for the lower salary is that the owner is taking a chance on you. The practice cannot afford to pay you $175,000 guaranteed salary your first year out of residency because you don’t even have any established patients yet! What you should be hoping for is a decent base salary and a good performance based bonus structure. That means the more money you bring into the practice, the bigger bonus you get, which should make you work harder so you can get paid! Do that for a year or two, and now you have some leverage to renegotiate your contract for a larger base salary.

Another problem I see is that a lot of residents are applying for high-volume trauma positions or Orthopedic group positions when they did not receive this type of training during residency. Yes, it can pay more, but if you aren’t qualified for the job, you’re going to be wasting time and money interviewing once and possibly twice for the job. Instead, you could be interviewing for a perfect job elsewhere before someone else snatches it up. Be realistic and honest about your skill set and personality and you will be able to find the right fit.

“Do I Need a Fellowship?”

I get this question A LOT from both residents and students. My answer is always the same: If you’ve had a well-rounded residency experience, you likely don’t need a fellowship. If you feel like you need more confidence in the operating room, go do a fellowship. If you had a void in your residency training and you are uncomfortable with it, go do a fellowship. If you want to be seen as The Expert in a certain subspecialty, go do a fellowship with a targeted focus. It is all a personal choice that only you can answer as you are going through your training.

Remember the Podiatric Roots

80% – 90% of most Podiatrists’ time is spent in clinic. The best thing you can do in residency starting Day One is to learn how to perform a good clinical exam and treat patients conservatively when possible. If you didn’t and you’re at the beginning of your PGY-3 year, you have time left to polish your skills. Most patients don’t want to have surgery unless they absolutely need it. Yes, you may be able to put in a Total Ankle Replacement in 2 hours with no jig and no fluoro, but can you give a proper Hallux anesthetic injection for a nail avulsion without the patient screaming? Don’t overlook where Podiatry came from by focusing too much on surgery. You should be able to teach the PGY-1s & PGY-2s how to do almost everything in clinic during your PGY-3 year. That’s when you know you’re ready.

Board Certification

Getting board certified as fast as possible is the most important professional accomplishment a recent residency graduate can obtain. It allows you to get on insurance plans quicker, get hospital privileges quicker, you will likely get a bump in your salary for being board certified, and it looks professional. The great thing about the ABPM is that you are able to take the qualification exam during residency and the certification exam the Fall after, thus becoming board certified as soon as 4 months after completion of residency. I like to refer to the ABPM as the “Board of What We Do Everyday.” It truly is the only certifying board that recognizes what we do on a daily basis and is one of two Podiatric board certifications recognized by the JCRSB (the other being ABFAS – which can take 1-7 years to obtain). It is important to get board certification quickly and in my opinion, every graduating resident should be signing up for and taking the exam. Dual board certification is very important and I believe all practicing Podiatrists should obtain both ABPM and ABFAS.

My hope is that each resident gets at least one nugget of information out of this article. My advice, especially for those just starting residency, is to remember that this is your last chance before you enter the real world. Once you get that residency certificate, you are practicing under your own license on your own patients. Soak up everything in residency and it will pay dividends for your future. And never forget, “Treat every patient like they’re your mother.”

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Jonathan D. Rouse, DPM is a Diplomate of the American Board of Podiatric Medicine. He is the Chief of Podiatry at the Captain James A. Lovell Federal Health Care Center in North Chicago, IL where he also serves as the Residency Director. He is active on multiple national committees and is very passionate about the growth of the field while still staying true to its roots.
You can follow Dr. Rouse’s adventures on Instagram by following @docrousedpm

ABPM Exhibits at the American College of Physicians Internal Medicine Conference

Dr. Mitchell Shikoff at the ACP Internal Medicine Meeting

Dr. Mitchell Shikoff at the ACP Internal Medicine Meeting

By: Mitchell Shikoff, DPM

This past April I had the opportunity, along with our assistant Executive Director, Marc Benard, DPM, to exhibit at the American College of Physicians Internal Medicine Conference in Philadelphia, PA. This conference is the largest medical seminar in the country. It is attended by over 11,000 physicians yearly representing countries from around the globe. This was part of our outreach to medical specialties to showcase the ABPM and the benefits of incorporating ABPM diplomates into treatment plans for their patients with lower extremity pathologies. Our attendance was received enthusiastically by the conference organizers and the hundreds of physicians who came to our booth. We were told repeatedly about the value of podiatrists to the individual practitioners and their respective hospitals. Many contacts were made and referrals recommended for ABPM diplomates around the United States.

We also had the opportunity to monitor some of the lectures and clinical skills breakout sessions. I was able to make contacts with the organizers of the conference to investigate the inclusion of speakers from the ABPM in future seminars. Dr. Benard and I submitted a proposal for the ABPM to conduct clinical skills sessions to the conference organizing committee. I am happy to report that our proposal was accepted and, in fact, a request was made by the committee for an even larger role than our proposal.

It is our belief that this is the first time that podiatry has been represented at their conference and will be the first time that podiatry will become part of the faculty.

We are following up on this success with our attendance at the second largest medical seminar in the country at the end of this September. We will be exhibiting at the American College of Family Physicians conference in Philadelphia.

We see these outreach methods as a value added service to our diplomates and a grass roots effort at achieving parity in the medical community.

ABPM Board of Directors 2019-2020

We are pleased to announce the results for the 2019-2020 Election of Officers!
(L-R) Drs. Chagares, Geller, Rogers and DeLauro
(L-R) Drs. Chagares, Geller, Rogers and DeLauro
The following Diplomates make up the current ABPM Board of Directors:

W.E. Chagares, DPM, President
Stephen M. Geller, DPM, Vice President
Lee C. Rogers, DPM, Treasurer
Nicole M. DeLauro, DPM, Secretary
Gina M. Painter, DPM, Immediate Past President

Melissa J. Lockwood, DPM, Director
Coleen Napolitano, DPM, Director
Bryan J. Roth, DPM, Director

Marc A. Benard, DPM, Assistant Director
James W. Stavosky, DPM, Executive Director

We would also like to thank the following Directors who are leaving the Board for all of their dedicated service to the ABPM:

Steven L. Goldman, DPM
Mitchell D. Shikoff, DPM

 

 

The American Board of Podiatric Medicine
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