Advice To Graduating Residents Embarking On A Life In Practice

Recently we went to my podiatry school roommate’s son’s wedding. It was a grand affair. I couldn’t believe the groom’s dad, like me, is already in his 60s. As my father always questioned: “Where has the time gone?”

So the couple is on their way to a lifetime of love, happiness and great times. Those of us already married know that life will bring to them some obstacles along the way. A good couple withstands anything thrown at them and somehow gets stronger. While they just got married, these two look like they could withstand anything and they are so idealistic, which is fantastic. Here is hoping they stay that way.

Two days later, our two third-year residents were honored at their graduation dinner. They too are idealistic about joining their respective practices. Just like the married couple, each will encounter many obstacles during their careers.  Naturally, they too will have to roll with the punches and keep practicing.
How do we know?

If you have been practicing for any length of time, you know how much medicine has changed. What profession has seen payments decrease over time? How low can they go? The myriad of regulations one must slog through to keep an “entity” at bay is time consuming and distracts from providing care, not to mention the impact of these regulations on the bottom line. Let’s just call these regulations “unfunded mandates.” How many actually enhance patient care?

How about the electronic medical records system, which is good but keeps us clicking endlessly to satisfy either a person or another set of regulations? What will it look like 10 or 20 years down the road?

Will we see the arrival of single payer health care? Will that help or hurt our medical system? Maybe we need to study the United Kingdom’s health care model a little more.

We kind of know the United States health care system is broken and needs fixing. We could fill this entire journal with suggestions and ideas. The one or few who solve the problem will surely go down in history.

For both the married couple and the residents, I would like to offer some advice.

• It goes by much too quickly.
• Try to enjoy every moment the best you can.
• Don’t let any obstacles get in your way. Find ways around them.
• Find an outlet, whether it is sports or a hobby.
• Read for pleasure as much as you can.
• Develop more friendships and fewer acquaintances.
• Take time to relax and unwind.
• Broaden your horizons by traveling.
• Know when to say when.
• Participate in a worthwhile cause(s).
• Don’t go through life being angry.
• Keep up with current events.
• Love is the key.
• Meditate at least daily.
• Keep close to family.

For the residents, I would to offer a few more specific pieces of advise.

• Keep up with the literature.
• Obtain your board certifications as quickly as you can.
• That foot and ankle are attached to a person.
• Try to keep the practice in your office and don’t bring the worrying home with you.
• Complications are a part of what we do unfortunately. Learn from each. If you don’t want any or for that matter don’t want to be sued, then you will have to leave practice.
• Realize the rare privilege you have: to help someone get better.
• Be honest with yourself, the patients and in fiscal/insurance matters.
• You are in debt and you always will be with that mortgage, etc. Don’t look at a patient as a money tree.
• Have fun with your staff, the patients and your family.
• Act like the professional you are.
• Train a resident just as you were trained.
• Be a mentor.
• Don’t capitulate to anyone because you are “just” a podiatrist.

Now, both the couple and the residents sure as hell would not want to listen to all of that advice, at least not now while they are in the moment. My old roommate, as I know him, most likely sat his son down and did offer some advice pre-marriage. That’s the way he does things, being the kind of caring father that he has become.

However, I hope they keep the above points in mind as the days turn into years.
Maybe the biggest key to all of this is for the couple never to forget what brought them to the marriage and for residents to never forget why they wanted to be a part of this profession. When times get tough, and they will, try to remember that time when you were idealistic.  

To the four of you: Peace, blessings and good luck!

Oh to be young again ...

Dr. Wallace is the Director of the Podiatry Service and the Medical Director of Ambulatory Care Services at University Hospital in Newark, N.J.