Insights And Reflections From Third-Year Residents In The Last Months Of Residency

Third-year residents discuss juggling future requirements for practice, what they’re focusing on in current rotations and reflect on their residency experience.

Q:

As you start your last months of your residency program, what are the most important things to do that are at the top of your list? Licenses, hospital privileges, contracts?

A:

Catlea Gorman, DPM, says she was surprised by how long it takes to get approval for your license, DEA registration and hospital privileges.

“I would recommend getting started on these things as soon as you can. That way, you can avoid delays prior to starting your job,” advises Dr. Gorman.

In the midst of working to complete state licensing and obtaining DEA registration and hospital privileges, Heather Schaefbauer, DPM, is also house hunting and starting to pack.

Wesley Jackson, DPM, says he was fortunate to sign a contract at the beginning of his third residency year and took care of state licensing a while back. He says the biggest thing on his list right now is securing credentialing for insurance companies, the practice and hospital privileges.

Dr. Schaefbauer adds that she is also wrapping up any remaining research projects and trying to gain experience performing less common procedures she may not have been exposed to thus far.

Q:

What rotations are you doing in these last three months? Are you spending extra time learning about more about billing, coding, etc.?

A:

Drs. Gorman and Schaefbauer note that all off-service rotations are complete by the third year and they spend the entire third year on service. In her third year, Dr. Schaefbauer adds that she has gained “a lot of experience with larger, more in-depth cases.” By being fully on service, Dr. Gorman emphasizes that “this allows us to focus our attention and tailor our schedule to get more experience in certain areas.”

Dr. Jackson notes that one rotation he had in April had him on the hospital floors and involved with inpatient surgeries. He says he will be spending time on office rotations in May and June to help tweak his billing techniques, and enhance his knowledge in that area.

“The number one priority for third-year residents in the last half of the year really should be billing and office management if you are not taking a hospital job,” notes Dr. Jackson. “Obviously, you should try to get in as many surgeries as you can, but the office and billing is where you practice the majority of your career.”

Drs. Gorman and Schaefbauer note that their residency program emphasizes billing and coding for surgery and the clinic setting throughout the three years of residency. That said, Dr. Schaefbauer says she is focusing more on surgical billing and coding in the last couple of months, and Dr. Gorman adds that she taken more of an interest in billing and coding in the past year.

“I would encourage residents who do not get as much experience in billing and coding to take the time to learn this aspect, and ask your attendings questions,” advises Dr. Gorman. “It is easy to overlook the importance as a resident but soon you will be an attending, and it is a valuable skill to have no matter what practice setting you are going into.”

Dr. Gorman also points out that she is spending more time in the clinic setting. While she says many third-year residents want to focus on big surgical cases and operate all the time, Dr. Gorman notes she has been advised to make the clinic setting a focus in her third year of residency.

“As residents, we may operate every day but the reality is that as an attending, you will likely be in clinic three to four days per week,” emphasizes Dr. Gorman. “You want to be comfortable and efficient in clinic so you can hit the ground running once you are on your own.

Q:

Looking back on your residency, if you could pinpoint it, what was the most valuable part of your residency training? What, if anything, would you do differently in your residency years, if you had to do it over again?

A:

“Residency is about surgical training. Being able to physically do the surgery was the most valuable part of residency,” maintains Dr. Jackson. “Having countless times to practice your dissection, bone cuts, closure etc., is monumental to you progressing as a surgeon. I am very grateful to all of my attendings for such experiences.”

In retrospect, Dr. Jackson adds that If he had to do it over again, he would have pushed harder to do more surgeries earlier in his residency so he could concentrate on other things to fine tune his skills in his third year.

For Dr. Schaefbauer, the most valuable part of residency has been becoming comfortable and efficient with different aspects of patient care including clinic and surgery along with taking calls and seeing consults at the hospital. Once you become comfortable with these things, Dr. Schaefbauer says you can focus more on things like billing and coding as well as patient education and satisfaction.

While Dr. Schaefbauer says there are not many things she would change about her residency experience, she notes she would have started becoming comfortable with dictating clinic notes and procedures earlier to ensure efficiency once she starts practice.

Dr. Gorman praises the “comprehensive training” she has received in her residency program and wouldn’t change anything about it. She says the most valuable aspect of her training was the “continuity of care” aspect.

“At my residency program, you’re the one seeing the patient in the emergency department, scrubbing the patient’s surgery, following him or her as an inpatient and seeing him or her postoperatively in the clinic,” explains Dr. Gorman. “The same goes for our clinic where the resident is seeing patients, discussing the plan with the attending, scheduling the surgery, then scrubbing the case and seeing the patient postoperatively. This structure allows the residents to be involved in the patient’s care from start to finish, which I think prepares you for what your role will be as an attending when you graduate.”

Dr. Gorman is the Chief Resident at Regions Hospital/HealthPartners Institute for Education and Research in St. Paul, Minn.

Dr. Jackson is a Chief Resident in the Podiatric Medicine and Surgery Program at Main Line Health in Bryn Mawr, Pa.

Dr. Schaefbauer is a Chief Resident at Regions Hospital/HealthPartners Institute for Education and Research in St. Paul, Minn.

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