Practice Perfect 817
It's Time to Start Practice

For those of you that just graduated from residency, congratulations! Your journey of education has brought you to a new starting point. Seven to nine years of diligent training and hard work have left you on the threshold of a new vista of your professional adventure. It’s exciting and a little scary. Most of you have negotiated a work contract with your new employer, and perhaps a tiny number have even started your own practice. There are so many things to consider, so let’s talk about a few of the many topics of which you may or may not be aware. 

Never forget what it’s about - I know this might sound corny, but always keep in mind why you became a medical provider: to help patients. It’s too easy to fall into the trap of focusing on making money. You need income, it’s true, and you should aim to make your practice as successful as possible, but being a healthcare provider means working hard to successfully treat patients’ illnesses to the best of your ability and training. Do this first and the other things will fall into place. 

Remember it’s a “practice of medicine” - No matter how advanced and comprehensive your training was, you still have a lot to learn. After 17 years of practice, I’m still learning every day. That’s one of the things that makes this endeavor interesting. Enjoy your successes but focus on mistakes and complications. Examine your outcomes and figure out what you could do better in the future. For example, track your outcomes for common procedures and see where you can improve. Did a particular orthotic modification help patients with plantar fasciitis better than others? How long did the edema last after your Lapidus procedures? Why did that particular surgery have a nonunion? Think about these outcomes with a dispassionate mind and apply improvements that you watch over time. A thoughtful approach will yield huge benefits later.

A thoughtful approach will yield huge benefits later

Prepare for board certification now - I strongly suggest becoming board certified with the American Board of Podiatric Medicine in October of the year you graduate. It’s a faster track to certification that will take the pressure off becoming surgically certified ( Once you do that, become a member of the American College of Podiatric Medicine ( This college has many benefits, including continuing education and a supportive network of colleagues, among many others. For those of you surgically inclined begin preparing yourself for certification with the American Board of Foot and Ankle Surgery ( This board has a more complicated process, especially for the case submission part, that is doable but will require time. Don’t wait for the last minute. As in residency, you have to log your surgical cases ( However, the board has very specific requirements about what aspects of your cases are submitted, and you should carefully read their requirements. Log as you go and don’t procrastinate! Remember that if you leave your current job and go elsewhere you may not be able to acquire the documentation you need, so build your files now. If you’re not already a member, join the American College of Foot and Ankle Surgeons (

Log cases as you go for board certification and don’t procrastinate!

Start building your practice - If you’re entering private practice, it will be necessary to market yourself to your community. If you are a new associate with a boss that feeds you patients, congratulations; you’re lucky. But even if you are, remember that podiatric practices are primarily referral-based. In your spare time go out and meet a potential referring provider. Join a committee at your hospital. Eat lunch in the doctor’s lounge. Do some lectures at your local community center. Reach out to local physical therapists and other specialists. Use this to build the aspects of practice you most love. Is Charcot reconstruction your passion? Meet endocrinologists, nephrologists, and primary care physicians. Show them what you’re capable of. Enjoy treating children? Meet the pediatricians and family practice doctors. Whatever you do, don’t sit on your laurels, and think there’s an endless flow of patients just waiting for you to treat them. Actively build your practice. 

Actively build your practice

Invest in retirement now - This may sound boring and long into the future, but the time to invest in your retirement is right now. It takes time for that all-important compounding to work. A small investment of money in a Roth IRA now will yield major dividends in the future. Remember, also, that as your income builds so will your tax burden. Look for ways to decrease your taxable income so you can remain in a lower tax bracket. Plan for your future – it will come whether you like it or not. You won’t stay young forever. 

Plan for your future

Be strategic about proctoring - Hospitals and most surgery centers will require your first surgical cases to be proctored. You will most likely be assigned a podiatrist to watch you do your first cases to be sure you can do those procedures for which you have been granted privileges. Generally, this is a collegial process, but I suggest picking easier cases to start if at all possible. Don’t schedule a long flatfoot or Charcot reconstruction as your first cases. Instead, aim for smaller procedures such as bunionectomies and soft tissue mass excisions. It can be intimidating having someone watch you early in your career, and you’ll be surprised how draining these cases can be. Your attendings are gone. There’s no safety net. Additionally, getting used to that new OR will take a lot of mental energy and your proctor doesn’t want to sit there for four hours watching you fix a Charcot foot. 

Pick easier cases to start

Finally, don’t forget about yourself - There’s a lot of work to do as you start out, and much of it has to be done “now.” But it’s also to important to take care of yourself. Spend time with your significant other as much as possible. Invest in your personal relationships just like you do in your professional time. Family is usually the first aspect of our lives to be sacrificed because they love you and will wait. But even love has its limits. Avoid your family to your detriment. Remember, you deserve and need personal time. Visions of your loved ones will keep you going especially in those hard moments when things at work aren’t going your way. Yes, it will happen; there are no shortages of challenges in practice, but a combination of good training, increasing experience, and relying on the love of your community will carry you through.

You deserve and need personal time. Don’t stop investing in your personal relationships

Good luck on your new practice and best wishes.
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Residency Summit East 2022

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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