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Tips On Navigating The ‘Real World’ Of Podiatric Practice

July 1 has come and gone again, and with it comes a new influx of clinicians hitting the “real world.” After eight or more years of school, three to four years of residency and possibly one year of fellowship, we’ve finally made it or so we think.

Just completing my first week, I can honestly say it was tough. From an intelligence perspective, I was well prepared and feel confident in all of the excellent training I have received. One thing no one taught me was what to do when the number of patients you see per day ranges between five and 10. Physicians fresh out of residency or fellowship are used to, trained for and desire the hustle and busy clinical schedule. However, to transform one’s practice into a busy, rewarding and profitable endeavor, now is the time to lay the groundwork while (free) time permits.

Below are some of the things I found myself doing this past week. After doing my own research online (“being a new doctor,” “building medical referrals,” etc.) and asking past and present associates, I compiled a helpful “to-do” list. Just because you are slow with patients, it doesn’t mean the time has to drag by and not be productive. I still felt like I was hustling and had a full day, but in a different way.

Electronic medical records (EMR). Learn your practice’s EMR system. Know where everything is on it. Create templates for the common pathologies you see and treatments you recommend. All of this will prove to be a valuable time-saver when your schedule is full and you want to stay on top of charting during the day instead of spending another two or three hours after work finishing your documentation.

Billing. Review billing from ICD to CPT and from office to surgical billing. As stated in a recent Podiatry Today DPM Blog, residents coming out have limited knowledge on billing practices.1 For those still in residency, make sure to spend time in the office questioning your attendings about billing practices, techniques and tips. Study your office billing sheets and create a list of surgical CPT codes that are commonly in use when operating. This will allow you to bill appropriately and efficiently instead of wasting precious time looking up codes during or after hours.

Protocols. Create protocols for treatment to help streamline your practice. You can even turn these into handouts for patients to dispense so everyone is clear on the course of action. I have made an entire catalogue of protocols from plantar fasciitis to ankle fractures, all printable at the click of a button during office hours.

Staff training. You obviously have an idea of how you envision your office day running. Take the time to teach your staff how you want things to flow, give them the protocols that you have developed as a guide for them as well and train them on how to perform certain tasks (for example, applying casts and postoperative dressing changes). All of this will allow your day to run efficiently, effectively giving you the ability to see more patients.

Canvassing. Introduce yourself to the local medical community. This is probably the most important but also the most awkward part of beginning a new practice. Map out, search and visit local potential referrals. This includes physicians in primary care, pediatrics, rheumatology, infectious disease, emergency, orthopedics and even other podiatrists. Other good sources of referral are local middle/high schools, physical therapists and lawyers (liability, personal injury, worker’s compensation). I created an introductory letter stating my background, skills, interests and office information, and either mailed it, emailed it or personally dropped it off (with business cards) to each of my potential referral sources. Other important introductions include local medical representatives for products you may use from office supplies to surgical hardware.

Learn local doctors. Search local referral doctors for specialties important to you (as stated above) and create a working list (possibly even a handout) for your patients. Do not just review their credentials and online grades, but personally visit them. Know the local physical therapy offices where you may refer. One doctor told me he went for a few hours just watching the therapist-patient interaction before he would consider a practice as a referral base. Learn where you can find local durable medical equipment (braces, boots, crutches, knee scooters) with the product’s price (again, make a handout). People will see you as a reflection of who you refer someone to. Anyone, including your patients, can find a list on Google but if you take the time to visit all these sources of two-way referral and compile a thoughtful guide for your patients, they will really appreciate it. All of this will allow you to make an informed decision about who you are entrusting in the care of your patient.

Learn local geography. Just because you are new to a town, city or state, patients still look to you for direction regardless of your knowledge of the area. Take time to learn the names of local towns and what the community has to offer.

One of my attendings in training used to say every year at graduation “You think you have made it but you really haven’t.” The realization of this occurs in the first few months of work. The more you can be proactive in that time period, the quicker you will develop the practice into what you want and start to truly make it. Taking the time initially to enact some of these tips above will increase patient confidence and speed the growth of your patient base, putting you on the path for success.


1. Weil L Jr. Are residencies really preparing doctors for practice? Podiatry Today DPM Blog. Available at . Published May 4, 2016. Accessed Aug. 10, 2016.

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