How Residency Has Changed Career Perceptions And Influenced Career Plans

Third-year residents discuss how their residency program experiences altered their journeys, changed their career perceptions and prepared them to make career choices.

Q:

Please explain how your thoughts and perceptions about your podiatry career have changed throughout your time in your residency program.

A:

For Brandon Tucker, his residency program experience took away the pressure of having to find the “perfect” job right away.

“There is a misconception amongst residents and even students that the job you get out of residency is the job you will stick with for the rest of your career,” he says. “This isn’t something we are taught.”

Dr. Tucker recalls feeling relived when he realized that he wouldn’t have to incorporate every aspect of podiatry into his future practice.

“There is a saying at my residency: ‘Learn everything you can, but practice what you want,’” he says.

Jamie Dermatis, DPM, shares a similar sentiment. She entered her residency expecting that her career in podiatry would primarily consist of performing elective rearfoot reconstructive surgeries, such as total ankle replacements and flatfoot reconstructions.

Dr. Dermatis says that she now understands that a career in podiatry more extensively involves limb salvage and diabetic foot care, in addition to a few things she might not have had the chance to experience yet.

“Given that podiatry is a constantly evolving field, it would be impossible to learn everything in three short years,” she says. “I now realize that I will continue to grow and learn beyond graduating residency through my own experiences as an attending, reading literature, and attending lectures and conferences.”

Thomas Wright, DPM, notes that not everything can be learned from a textbook. He explains how real patient interactions during his residency changed how he approached his time as a resident.

He recalls one patient in particular, a 16-year-old male who had fractured all the metatarsals in his foot. Upon meeting the attending, Dr. Wright was asked if he had read about this particular injury. He confirmed that he had, and was assigned to the case.

“I hadn’t expected so much responsibility and trust so quickly,” says Dr. Wright. “Immediately, I thought, this wasn’t in the textbook! This is a real kid with real parents. Who am I to be entrusted with so much?”

For Dr. Wright, this experience motivated him to go beyond the “textbook” answer. He says the focus shifted from being required to know something to pass a test to wanting to know something in order to help patients with complex conditions and solve difficult problems.

“I now love being the person to tell a patient, ‘I know you’ve been told you have chronic ankle sprains but you actually have a coalition. Here’s how you get better,’” notes Dr. Wright.

Alexandra Scrimalli, DPM, recalls a time when her textbook lessons played out before her eyes. It was her first weekend on-call without an upper year resident’s supervision, and she was called to the hospital for a traumatic closed ankle injury caused by a motor vehicle collision.

“I came back from the supply room with all my splinting supplies in tow, and my patient was losing color to his foot, was in immense pain, and lost his pedal pulses,” says Dr. Scrimalli. “Everything I learned in my trauma class had just happened in a few short minutes.”

That experience changed how Dr. Scrimalli approached her time in residency. She embraced every opportunity and even followed her surgical patients’ progress as outpatients.

“Whether it is an infection, wound care, diabetic limb salvage, tendon ruptures, reconstructive surgery, or trauma, I made it my goal never to shy away from my experiences,” explains Dr. Scrimalli.

Q:

What type of podiatric practice do you see yourself involved in and why? Do you want to work with an orthopedic group that would involve mostly surgery, or a mixed podiatry practice of surgery, pediatrics, sports medicine, diabetic foot care, and general foot care?

A:

Dr. Scrimalli desires a mixed-podiatry practice or a podiatry-friendly orthopedic group with a collaborative, team-focused approach to treating patients. She says that her ideal practice would deal with all of the aforementioned aspects in addition to trauma.

“With medicine shifting toward a more comprehensive approach, it is convenient for the patient to have their providers inherently linked for better outcomes,” she says. “It’s also important for me to be in this type of environment because there is an open interaction with patients, staff and colleagues.”

Dr. Wright acknowledges that he will always continue learning from those he works with but his preferred career path is clear. Retaining patients while providing additional options for treatment is his goal.

“I see myself being able to bring to the table more ankle, rearfoot and midfoot surgical options that other providers might refer to someone else,” notes Dr. Wright.

Dr. Tucker has already secured a position in a multispecialty group. He credits his residency experience with offering him a respectful, collaborative environment that he wanted to emulate in his professional career.

“Working in a multispecialty group will afford me some of the same benefits that would allow for more collaboration with residents on behalf of my patients to enhance care,” says Dr. Tucker.

Dr. Tucker says that he would like his practice to be a mix of general podiatry, sports medicine, pediatrics, and surgery. He enjoys most aspects of podiatry and wants to see a variety of pathologies.

Dr. Dermatis says she is open to working with either an orthopedic group or a podiatry practice, but feels that a mixed podiatry practice would be the best fit for her overall.

While she enjoys the surgical aspect of podiatry and sports medicine, and would therefore welcome the chance to work with an orthopedic group, Dr. Dermatis feels her potential for growth would be more restricted in that practice environment.

“Most orthopedic groups I have encountered already consist of one fellowship-trained foot and ankle orthopedic surgeon, therefore limiting the role of a podiatrist to wound care, nail care, and performing only forefoot surgeries,” notes Dr. Dermatis.

She believes a mixed podiatry practice would expose her to a greater diversity of pathologies and a broader range of clinical experiences.

“I envision being treated as more of an equal and being given more opportunities to perform a variety of surgeries, including rearfoot and trauma surgeries,” says Dr. Dermatis.

Q:

How has your residency program prepared you to make your career choices? Do you discuss job opportunities with your attendings and residency director? If so, how has this been helpful?

A:

Dr. Wright believes his program prepared him for just about anything. He notes that everything he believed at the beginning of his residency program turned out to be true, including how quickly the three years would go by.

“I truly believed that I would need to make sacrifices and work hard, taking those very complicated and challenging patients, being the resident known as the ‘hard worker’ and covering the night and weekend cases, seeing the most patients, doing the most surgeries, and being the problem solver,” maintains Dr. Wright.

Dr. Wright also notes that he was able to discuss his future career path with many different attendings and mentors.

For Dr. Scrimalli, her job hunt highlights the unique and well-rounded nature of her residency program. She discusses job opportunities with her attendings and residency director on a weekly basis, and also attends monthly meetings—including a lecture series on loan consolidation, financing, and contract negotiations—with other residency programs across their health system.

Dr. Scrimalli says that her program is affiliated with multiple private practices as well as podiatric surgeons who work in an orthopedic group.

“This provides a unique benefit when I have a specific question about practice dynamics and allows a different perspective of what makes one job more appealing than another,” she explains.

Dr. Scrimalli notes that she is grateful for the support of her attendings, who are always willing to chat and brainstorm ideas whenever she discovers potential job opportunities. Talking to them about the pros and cons of possible places of employment also helps Dr. Scrimalli narrow down her most important questions and concerns regarding a specific job opportunity.

“Listening to their thoughts, opinions, and advice before making any real decisions is important to me. They have the experience,” she says. “Podiatry is a small world, which is a great asset to this profession.”

Dr. Wright says that he too is grateful for the help and guidance offered by his attendings. He mentions how they assist with all stages of the employment application process, from reviewing resumes (“essentially a first impression with a potential employer,” says Dr. Wright) to looking over the contracts and referring residents to experienced legal counsel once a job offer has been made.

Dr. Dermatis says her program exposed her to a diverse group of podiatric attendings and helped her figure out what career path would be the best fit.

“While I have performed a lot of inpatient care, giving me exposure to hospital-based podiatry, I have also spent time shadowing podiatrists in orthopedic and private podiatric practices,” says Dr. Dermatis.

She says that she values the opinions of her attendings and feels that obtaining their perspective will help guide her in making the best career decision possible.

Dr. Dermatis is the Podiatric Surgery Chief Resident at the Eastern Virginia Medical School in Norfolk, Va.

Dr. Scrimalli is the Chief Resident with the Bryn Mawr Hospital/Main Line Podiatry Residency Program in Bryn Mawr, Pa.

Dr. Tucker is the Chief Resident within the Podiatry Residency Program at University Hospital in Newark, N.J.

Dr. Wright is a third-year resident at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix.

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Wayne, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.