Towards a new paradigm

Dear Colleague,

Call me a journeyman or middle guard since I have been in podiatry for a mere decade. I missed out on the "golden era" of medicine when you could name your price for procedures and services. Call me a realist since I never expected to make a "million" overnight or even a CEO's salary after graduating from residency. I happened to graduate from residency at the worst possible time, when HMO's, PPO's and Managed care were just taking over. You remember, when everyone was signing up for whatever plan they could get their hands on regardless of fee schedules or regardless of even getting paid for services rendered. When a month's worth of claims could suddenly "disappear" from an insurance company office and malpractice insurance only kept going up in price.
I persisted though, not because I particularly enjoyed the challenge of waiting on hold for an hour as some HMO functionary tried to "find" my claim or enjoyed being paid by other podiatrists at the hourly nurse's rate but because I had no choice. During those years, I learned quite a bit through trial and error, long days working at other podiatrist's offices and many nights of worrying. This is the reason, I continue to post on this web site and educate the more recent grads about the reality of our profession and for that matter, of medicine in general.I object to those hit and run commmentaries where a podiatrist gives you all the negatives (real or percieved) about podiatry without regard for the fact that it has made many practitioners successful after all and without regard for the greater context of the state of medicine in general. I am not blind to the plight of the new graduate and I still consider myself relatively new although I am now in a more successful stage in my career. I do believe however that the approach you mentioned in your post is no longer the way for any new graduate to go. That is; the open up cold approach. I have seen too many fail by needlessly attempting to go from zero to sixty without even getting out of first gear.
No doubt, the older established pods have much to answer for; including poor pay, lacklustre residency experiences, national board obstacles and licensing blockades. Rather than try to change human nature and waste my time fighting the tide, I chose to work with what I had and change my perspective. Change my context from one of automatic,high expectations to one of success despite the problems.
Start with a different approach. In today's medical field it is nearly unheard of to open up "cold". That is; graduate, find a location and hang a shingle. This is because the costs of starting up a practice are prohibitive in most cases (rent, equiptment, staff, resources, supplies, utilities and computer support/software just to name a few). If you are lucky enough to have a generous mommydaddy endowment, go for it and consider yourself one of the lucky few. If you are like most of the graduates you must approach the entire post-residency experience entirely differently and more pragmatically.
First, don't expect a high paying job to be waiting for you. Second, expect to work for a few years with another experienced podiatrist to pay your bills, (don't expect a very high income during this period)learn practice management, patient management and innumerable other skills not taught in college, pod school or residency. Don't expect to live the "high" life immediately (the hot sports car, the nice condo and vacations in Aruba will come in due time. Just not within the first two or three years after residency, in most cases. Expect to rent not own a home at first. Try not to complicate things immediately by having 5 kids and getting married or divorced within the first two to three years. In other words, concentrate on your profession and establishing your course. Save. Think about renting from an internist or medical group. Make connections at hospitals with clinics. Talk to colleagues about job opportunities. Do what you must to establish an income. Have a plan of action. A three year plan, a five year plan. Build your credit, you will need it once you are ready to make your big move. If you have a spouse or partner, talk frankly with them about the role they will have in working with you to succeed. Don't marry a golddiger or one who expects that you will have your own reality TV medical spot. Be realistic.
Abandon the unrealistic, naive attitude so prevalent in med/pod students today that success is assured. It is not and never was. What is assured is that with hard work, persistence, patience, some saving and a little bit of indifference to negativity, the large majority of folks succeed in podiatry and medicine.
My final thought to those who fear debt so much: Debt is a necessary evil. In some cases it helps(look up deduction for mortgage debt interest). Debt is meant to be repaid in the long term. Emphasis on long term and on repaid. Stop looking at the debt as a single figure which must be repaid within two years. Guard your credit rating like a hawk. When you are ready to make the big move to your own office, your own investment property or business loan you will appreciate the fact that you honored your repayment terms. And of course, don't go into debt for a profession you do not believe in. Be it podiatry school, business school, film school or the school of hard knocks. Good luck.