A Closer Look At The State Of Podiatric Residency Training

Alan Catanzariti, DPM, FACFAS, and Robert Mendicino, DPM, FACFAS

Although podiatry residents have opportunities for significant advancement of their skills, they also face daunting challenges that may not be receiving adequate attention in residency programs. Drawing upon their experience, these authors suggest a number of areas for improvement in residency programs, including research opportunities, business education and coaching on leadership skills.

   Future residents and program directors in podiatric residency training programs will face certain challenges as healthcare undergoes profound changes. How they manage these challenges in a rapidly changing healthcare environment will be critical.

   Those programs wishing to remain viable must provide residents with the opportunity to adapt and become successful in the future. We will have to provide our residents with the knowledge and skill to work their way through these new challenges.
Not so long ago, residents prepared for the business of private practice by memorizing a few ICD-9 and CPT codes. Virtually every graduating podiatric resident would go into private practice. Some would go into solo practice while others might join a group.

   However, this is no longer the case. Although our graduates continue to enter group practice, very few go it alone. Additionally, our graduating residents now take positions with “super groups,” multispecialty groups, hospitals or healthcare systems, academic centers, orthopedic groups, vascular surgery groups, wound care centers, etc. Furthermore, some of our graduates pursue fellowship training.

Emphasizing The Need For Education On Contract Negotiations And Other Business Skills

The opportunities for our graduates continue to grow. These opportunities have made entering the workforce much more complex. During my early years as a program director, a resident would ask me to “take a look” at a five-page contract on her behalf. Now residents ask me if I can recommend a competent healthcare attorney to review a 50-page document.

   I have come to realize that our residents are unprepared to navigate their way through discussions regarding contract negotiation. Our residents have limited exposure to business and practice management. They do not understand compensation packages, bonus structure, retirement plans, non-compete clauses, etc.

   Several years ago, a graduating resident would discuss her contract with the physician with whom she was joining practice. Now residents are negotiating with a MBA health executive who represents the hospital, group, practice, etc. Our residents just do not speak the same language. This can result in frustration, uncertainty and poor decision making, not to mention adversely affecting their financial well-being.

   Maybe we need to consider some type of deliberate business training to help residents through the difficult and complex process of securing employment upon graduation. Whereas our training programs have made tremendous strides in clinical and surgical training, we have been somewhat lacking in preparing our graduates for business.

   We need to help our graduating residents become financially successful. They will have huge loans to repay, families to support and be practicing in a more competitive and complex healthcare environment. Some formal business education would provide a higher comfort level and greater confidence for our graduating residents as they move forward into practice. This might also expose our residents to other opportunities such as healthcare administration. Furthermore, business education might better prepare our graduates to take a meaningful role within the medical community in promoting quality and safety, and in containing healthcare costs.

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