Gearing Up To Enter `The Real World`: Preparing During The Third Year Of Residency

The third year of residency has arrived and it is time to find a post-residency job. This year goes by very quickly and there are some things that need to be done in order to start work when you are ready. Many of these tasks come with costs that may or may not be paid by your future employer. It is important to understand what one needs to do to address these factors early in the contract and employment negotiation process.

• State DPM license. In my opinion, the first and most important step is obtaining a license in the state in which you intend to practice. Each state has its own licensure requirements. Some only require an application and background check. However, other states may require an exam. Also keep in mind that application fees are not the same in each state, and can be rather high. For these reasons, it is important to do your research and decide where you want to practice. Your state license will be needed to complete every other step toward practicing. The time it takes to actually obtain your state license may vary so do not let this hold you up.
• DEA number. It is important to know that this costs approximately $750. Some employers will offer to cover this cost but if not, you need to know how much these things cost. This amount can be quite detrimental to a resident at the last minute if he or she is not prepared. Your DEA number is necessary to prescribe controlled substances. The application states that this may take up to eight weeks for processing. You can certainly begin practice without a DEA number but if you plan on dealing with trauma or performing surgery right away, the DEA number is vital. Also keep in mind that individual states may also require separate physician registrations with the state to prescribe controlled substances.
• Insurance credentialing. This must occur before you can see patients. Medicare and Medicaid have provider applications online that are relatively straightforward. Applying for panels of private insurance companies can be much harder. There are some services out there that will help you with this task but know that doing it yourself can be very confusing and difficult.

The easiest way to go about this is if your future employer’s billing company is able to do this for you. Many billing companies offer credentialing at no additional cost. They simply need your license information and will apply for everything for you including Medicare and Medicaid. This process, as I have been told, can take several months or more. Waiting until the last minute to get this going could leave you ready and willing to work, but unable to actually see patients. Talk with your future employer about helping you accomplish this as soon as you can.

• Hospital credentialing. Contact all of the hospitals you intend to work with and find out what is required to become a member of the medical staff. Many hospitals require a credentialing fee, which can be unduly high. Every hospital has its own structure for adding new physicians so make sure you obtain details carefully. Many hospitals hold a board meeting to evaluate applications. Depending on when the board meets next will impact when you can start seeing patients there.

Another important piece of information to find out is what each hospital will let you do in terms of scope of practice. For example, there are two hospitals in my area within five miles of each other. One hospital grants podiatrists privileges to do everything we are qualified to do, including total ankle implants. The other hospital restricts podiatrists to forefoot-only procedures. These are two hospitals in the same city with very different policies. With this in mind, do the research and make sure you know what you are getting into.

Other Items To Keep In Mind

There are many things that will have to wait until closer to your start date at a practice. Malpractice insurance companies can give you a quote but will ultimately need an official start date to begin the policy. Some companies, like PICA, will give a discount to first-year practitioners but see who your new employer uses and go from there.

Obviously, most of us will pursue certification tracks with the American Board of Foot and Ankle Surgery (ABFAS) and/or the American Board of Podiatric Medicine (ABPM). See what your hospitals and insurance panels require. Keep in mind that if your hospital only requires you to be board-certified with no specific board requirements, you can be ABPM-certified within a year. 

Preparing For A Smooth Transition

There are a lot of moving parts this year, many of which may carry a monetary cost. When discussing a contract with your employer, make sure to bring up these costs to see how they can be best handled. If your employer is willing to pay, find out how to arrange that as things like your DEA number application require a credit card. If your employer is not willing to pay for these things, start saving now.

It is important to know everything you need to get squared away so you can come up with a timeline. It may not seem like something to waste time on now but things progress quickly. Not only do these tasks need attention but residency still brings a lot of responsibility as well in one’s third year. It is important to stay organized and on schedule. Next summer will be here before we know it and hopefully, we can all hit the ground running.

Dr. Bishop is a third-year resident at Alliance Community Hospital in Alliance, OH.