Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Hospitals: Mayhem or Marketing?

Classically, medical training of most stripes has occurred in the hospital system. This has been the case for the most part since the early 1900's, when Abraham Flexner's report revolutionized medical training in the United States. This is also true for a large percentage of the podiatric physicians and surgeons trained in this country. We "grow up" in the hospitals. And rightly so, this environment provides the complexity of pathology and opportunity to provide care that students, residents, and fellows need to learn patient management skills. The hospital system also provides a certain amount of chaos that is also important for those in training. Ever been involved in a code? There is a certain controlled chaos that makes for good television shows while also teaching important ancillary skills like rapid response and prioritization.

The last thing a physician with thirty or more patients per day wants is the unexpected.

Once we're in practice, this busy system, with its acute patients and controlled chaos, may not be quite as desirable. Private medical practice, in fact, relies to a great extent on routine and predictability. The successful private practitioner, of any specialty, will desire a large number of patients that can be moved through the practice without excessive drain on resources (time and energy being two important ones). The last thing a physician with thirty or more patients per day wants is the "unexpected." We all know about the unexpected, that last patient at the end of the day who, as you're walking out of the room, says something like, "Oh, doctor I forgot to tell you about this new draining bump on my ankle." So much for leaving on time. Or worse, if this occurs in the middle of the morning the doctor will run late for the rest of the day.

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Allen Jacobs, DPM, FACAS

If these two systems, the hospital with its chaos and the office with its routine, are at opposing ends of the practice spectrum, where do those of us who practice in both realms fit? This has been the situation for the majority of my practice life thus far. Personally speaking, I enjoy practicing in both the clinic and hospital. Since I get bored easily, the routine of practice day in day out can become quite tedious. This is one of the reasons I enjoy working at Western University – no two days are the same. Working at the hospital periodically provided a much welcome break in the monotony when I was in early practice.

RESIDENCY CRISIS in PODIATRY –
How Does This Affect You Personally?

Currently, there is a shortage of residency training programs to meet the required demands of our graduates. Interested and capable podiatrists in practice have many reasons to develop programs. Above the altruistic reasons there are direct personal benefits in starting residency training programs which may be significant. The following short video presentation will give you valuable insight and information.

VIEW the video below for a BRIEF PRESENTATION by Edwin Wolf, DPM
SUMMARIZING the issue and where it currently stands

Ediwn W. Wolf, DPM, MS - National Residency Facilitator

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Additionally, and perhaps most importantly, the hospital provides a marketing and business supplement to one's practice. First, the hospital is a large concentrated area of potential patients. I'm speaking in this case about the hospital staff. This is one reason I always wonder about those doctors who are rude to the staff. Do you think that scrub tech with heel pain is going to come to the rude doctor or the friendly one? Second, hospital consultations bring in a reasonable direct income (E & M code plus any procedures) as well as the indirect income when your patient is so happy with your care that she refers her family to you. Third, and just as importantly, this a concentrated area of doctors who are potential referral sources. If they like your hospital work they'll be bound to refer their office patients to you.

For those who have not pursued this part of practice (especially the young physicians) I highly recommend it. If you're going to incorporate the hospital into your practice, here are a few suggestions to help get you started.

Spend time in the hospital. Go eat lunch in the staff or doctors' lounge.
Introduce yourself to as many people as you can.
Carry your cards with you and be ready to give them out.
Take emergency room call.
NEVER refuse a consult request. If it's debriding, toenails do it. If the consult seems ridiculous, do it. You don't want to look like you're picking and choosing. The good will eventually come with the bad.
Be easy. Not that kind of easy you sickos. Be easy to contact. Leave one number for the hospital to get ahold of you. When you're there, make the staff's life easy. Clean up after yourself.
Be friendly. Everyone likes the kind, friendly person. Rudeness under any circumstances is inexcusable.
Befriend the nurses. Think the doctors run the hospital? Wrong! Nurses run the show. You want more business? Make friends with the people who run the hospital.
Be punctual. If your policy is to respond within 24 hours to nonemergent consults, then be sure to show up within 24 hours.
Be a teacher. People who work at hospitals are generally interested in medicine and are unlikely to understand what you do. Take the time to educate them without being condescending. This will give you the chance to demonstrate the expertise you spend so many years acquiring.

Whatever you do approach it from an organized standpoint and take it as a positive challenge. Don't let this opportunity pass you by. The hospital with all its chaos is a perfect practice builder. Good luck with your practice growth.