PGY-3 Year…Freedom at Last! Right?
How to be a stand out applicant for employment
By: Jonathan D. Rouse, DPM, DABPM
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)?
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.
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.
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.”
—-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