Starting Your Practice Off On The Right Foot After Graduation

William Fishco DPM FACFAS

Every year on July 1, a new group of graduating residents enter the real world of practicing podiatric medicine and surgery. To that end, I want to share my thoughts and give some advice for those who are embarking on a new chapter in their professional lives. All of my previous students and residents who have spent time with me in my office have heard this before. Since only a select few get to spend time with me, I would like to share this with everyone.

1. Do the right thing for every patient all of the time. This is the first and foremost principle that should be your modus operandi. I know you have a lot of debt, have been in school for 20+ years, want to collect surgical cases right away so you can become board certified, and you feel that you “deserve” a lot of stuff. Maybe it is a fancy car (red or black, at least six speeds, goes fast, and is the envy of every doctor in the doctor’s parking lot at the hospital). Maybe it is a big house in the best neighborhood. Well, you get the picture here.

The bottom line is this: if you go to work every day knowing that you have to make a certain amount of money to cover your bills (including all of the fancy toys that you deserve), you are setting yourself up for failure and frustration. Once you determine the best treatment for your patient that is based on financial measures, you just failed the first mantra. Remember, the only way you can make money in this business is to be busy treating new patients. If you do not follow this important rule of “do the right thing for every patient all of time,” you will not be busy. Shortsighted economic gains always lead to long-term failure.

2. Getting started. What is the best way to advertise your services and get your name out in the community? Is it newspaper/TV/radio ads? No. I am going to give you a tip that is not in the Marketing 101 class. You are well trained and you should be showing off by advertising yourself in your local hospital. In some towns and cities, the hospital may be the largest employer. If you hide in your office and don’t do surgeries in a hospital, you are limiting your exposure big time. For example, let’s say you use a surgery center near your office because it is convenient. You have exposure to about 20 people from that facility. These folks may typically include an anesthesiologist, pre- and post-op nursing staff, circulators and scrub techs. Now let’s look at the hospital scenario that includes a staff of hundreds of physicians and nurses, allied staff such as respiratory and radiology techs, janitors, administrators, medical staff office employees, IT employees, cafeteria workers, and the list goes on and on.

The bottom line is this: if you show off your skills and “advertise” what you can do in front of one of the largest pools of prospective patients, you have just succeeded in “direct marketing” to your target audience and it did not cost you a dime. Remember, don’t hide in your office and surgery center. Get out there and show off what you can do.

3. Your ego. Everybody has an ego and we sometimes have to keep things in perspective. If you are truly concerned about what other medical doctors think of you based on your profession, you will live the life of angst. How many times have we heard, “Oh, you are just a podiatrist” or “You are not a real doctor” (assuming that only real doctors can be MDs)? This phenomenon of “looking down” upon a person is a fact of life. It probably started with Adam around the time Eve showed up. Obviously, this can be a serious problem for those podiatrists who have a fragile ego in the world of DPM versus MD. To no surprise, there is the same problem among MDs as well. For example, a neurosurgeon may look at a general surgeon colleague as just a “general” surgeon. An internist may look down upon a family practitioner or a radiologist.

I could give you examples all day long but I know you understand what I am saying. Don’t worry what people think. Just do what you do best and life will be good.

4. Never stop learning. After completing a residency, it is easy to think you know everything. The truth of the matter is that you have just learned the basic skill sets to practice podiatric medicine and surgery. Learning has only just begun. Every day in practice is a learning experience. When you think you know everything and don’t need to keep up with the literature or do basic research on your craft, that is the day you should hang it up and find something else to do.

5. Protect your name. We have all taken the Hippocratic Oath, which states among other things to “do no harm.” That of course refers to treating patients but also remember to “do no harm” to your name. Your name is the single most important possession (asset) that you have. When your name is highly regarded in your community, you have succeeded. However, if your name has been tarnished (by performing subpar podiatry, being untrustworthy, being guilty of excessive/fraudulent billing, not doing the right thing for every patient all of the time, etc.), you will be doomed to failure. Not to mention you will have to deal with the personal demons that keep you awake at night.

6. Associate yourself with good people. We have all heard the expression of “guilty by association.” To elaborate on “protect your name,” get to know your colleagues in your community who have “a good name.” These are the people you want to establish a relationship with to collaborate, seek advice and to refer to for second opinions. You never know what will happen in the future and it is important to have these relationships.

7. More relationships. In addition to having podiatric colleagues, you need to establish a relationship with hospitalists, internists, vascular surgeons, musculoskeletal radiologists, pathologists and orthopedic surgeons. You need to be able to pick up a phone and call your radiologist to review an MRI over the phone, or ask an orthopedic surgeon if he could harvest an iliac crest bone graft for you. You need to be able to call a vascular surgeon because Ms. Jones, whose hammertoe you just fixed, is sitting in your office on her first postoperative visit and her toe is black.

You get the picture. You need relationships and you need to be plugged into the medical community. Once you have established that, other specialists will call you and reciprocate. You refer Dr. Smith knees and he will refer you feet.

8. Have fun. I can honestly say that I love being a doctor of podiatric medicine. I look forward to going to work and really enjoy my patients. I have a small practice with two employees and as a result of that, I really get to know my patients and their families. My patients bring me goodies to the office (doughnuts, cookies, cakes, lasagnas, you name it). It is not uncommon for patients to bring me T-shirts and other tchotchkes from their vacations.

The bottom line is this: you chose to be a podiatrist. Nobody made you do it so show your patients how much you care about them and fix their podiatric problems. Once you do that, you will earn the trust and respect you “deserve.”


Bravo! Excellent and inspiring article and advice.

A word of caution about #6. The honest practitioners who have confidence in their work and are genuine will help you along. Not all the "good names" out there will be so willing to help out or are open to the new kid on the block. Tread lightly and keep your eyes wide open in that regard.

Best of luck to all the new crew out there!

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