Who wouldn’t want a practice that operates with an equally distributed workload; synergistic work mentality, increased efficiency and productivity; improved office morale and less team burnout; trained hands to assist in more patient care thereby generating more revenue; professional customer service; and less time constraints on the practitioner allowing him/her more patient-focused hours? If you’ve ever given any thought to onboarding new staff in order to create some of these circumstances, don’t just JUMP IN and expect a miracle! It takes more than just a thought. It takes a plan.

The following is a six step outline that can help you put one together. 

Step One: Recruitment

• Where should we look to find new recruits?
  • Schools, social media, patients, eateries, internet job sites (Monster.com, Indeed, etc.), hairdressers, gym, anyone in hospitality (customer service positions, i.e. hosts, waitstaff, valet, front desks, etc.) Chat it up! Let people/patients know you are searching.
• How can existing staff help in the search?
  • Individuals tend to hang out with those who exhibit similar personalities. Ask your staff: “Are there more of YOU out there?” “What about the job attracted YOU?”
  • Staff input helps to evaluate the practice’s current staffing needs. Where is help most needed? In what ways do they see a new hire affecting workflow? (Good or bad)
  • Put an Employee Referral Program in place as an incentive for them to help.

Step Two: The Hiring, Interview, and Selection Process

• Assess application responses
  • Pay attention to “red flags” on resumes and eliminate those that do not meet your needs.
  • Follow up: Set up appointments for first interview.
    • Decide who will conduct this interview – Doctor or Manager
    • Use a standard questionnaire for consistency and fairness to compare apples to apples; take notes to review later.
    • Have your favorite interview questions ready. Refrain from asking illegal ones.
      • If you encourage an open dialogue with your interviewee, they may offer information you are not allowed to ask.
    • Initiate role playing scenarios – focus on behaviors, words, expressions.
    • Discuss basic job descriptions, wages & benefits, hours, travel.
    • Meet and greet staff; are first impression personality clashes obvious?
    • Highly recommended to set up a second interview for those who seemed promising! Learn as much as you can before pulling the plug on your selection.

Step Three: Orientation

• Conduct a facility walk-through with new employee on day one. Best to start them on a Tues or Wed as Mondays typically are a little too hectic.
• Formal introduction to staff and practitioners.
• Match peer mentor to new recruit.
• Assign email account and login info.
• Have new employee spend adequate time with Office Manager (or the like) to:
  • Review and sign all necessary work-related paperwork.
  • Explain workplace culture, set practice goals and milestones; help them understand the importance of their participation as a team player.
  • Set up a training schedule.
  • Review employee policies and handbook for rules; conduct and disciplinary actions; workplace safety.
  • Explain job, employee, and employer expectations.
  • Review the performance review process; how, when, why?
  • Present a thorough review and understanding of their detailed job description and responsibilities. Prioritize primary and secondary duties.

Step Four: Training (MAKE the time!)

• As part of active work duties, all new employees regardless of hired position should report to the following positions (requiring their focus for a one week period in each position) to shadow, understand associated tasks, and observe interactions of each role. This is mandatory and in coordination with the components of a Successful Proactive Training Model (described in detail below).

  Some observations entail:

  • Doctors (observe doctor-patient interaction, instruments, protocols, podiatric vocabulary and commonly treated conditions, supplies, etc.)
  • Medical Assistant (Proper patient rooming and exam room setup, sterilization, inventory, documentation responsibilities, etc.)
  • Receptionist (phone, scheduling, patient data, collections, patient communication, etc.)
• Components of a successful proactive training model:
  • Demonstrate task, 1) Explain HOW, 2) Clarify importance, 3) Encourage questions, 4) Trial Time to observe and monitor, 5) Allow them to perform task solo.
• Require note taking as a learning tool – notes should be checked daily for accuracy.
• Cross training.

Step Five: Job Expectations that should be reviewed regularly with ALL Staff/Team members (new and existing)

• Professionalism
• Risk Management
  • HIPAA Confidentiality/breaches/consequences
  • OSHA Compliance
  • Legal Scope of practice
• Communication Skills (The patient/Staff connection)
• Customer Service
• Basic knowledge of podiatric medicine
• Dealing effectively with difficult personalities
  • Demanding, Complainer, Perfectionist, Disrespectful, Chatterbox, RUDE…. Abusive?
• Competence, Accountability

Step Six: Retention

• GOOD MANAGEMENT and Leadership!
  • Incentives
  • Inspiring, fun work environment
  • Employee rewards, appreciation and engagement opportunities
  • Fair Compensation & Benefits
  • Growth Opportunities
  • Employee surveys: Because it is unlikely that every staffer is motivated by the same thing, the best thing to do is to ask and FIND OUT.

Turnover is expensive AND disruptive! A strong onboarding process will considerably increase the likelihood of a voluntarily longer-term, happier employee.

It's wintertime; many people attribute their cold feet to the frigid temperatures outside. Although cold extremities may be due to the body's response to external temperature, they could also be a sign of malnutrition and systemic diseases that a podiatrist should identify and address in conjunction with another medical specialist. A thorough history and physical examination are necessary to pinpoint the cause of their pathology. Symptoms may include weakness and pain in the extremities, sensitivity to cold, color changes to skin, and numbness during warming periods. As podiatrists, we need to be aware of the many factors that may lead to cold feet in our patients and therefore dictate their course of treatment.

Vascular disease affects many people, especially those with a history of smoking or diabetes. Patients have narrowed or calcified blood vessels that cause poor blood outflow to the extremities. This may result in cold toes or feet. A medical history and clinical examination consisting of a thorough vascular exam are necessary. Symptoms may include pain at rest, a few steps or blocks upon ambulation, and cold feet that do not resolve with warming. Patients should have noninvasive studies to check the flow status in their lower extremities to assess the patency of the major arteries of the foot. A vascular referral might be needed, as well as an angiogram to determine the location of the occlusion(s). Untreated peripheral vascular disease can lead to ischemic changes and gangrene with chances of limb loss.

Another vascular phenomenon causing symptoms of cold feet is Raynaud's (disease and syndrome). In addition, trauma, cold, stress, or scleroderma can lead to vasospasms constricting vessels flowing to the feet. Symptoms include extreme sensitivity to cold temperatures and possible changes in color, such as blue or purple tones in the cold and redness when warmed. Treatment is warming the feet with socks or placing yourself in a room with higher temperatures. Some patients may also take more drastic lifestyle changes by relocating to states with warmer weather.

 Other culprits causing cold feet symptoms could be related to medications such as beta-blockers, migraine medications, and pseudoephedrine. These medications can cause constriction of blood vessels causing symptoms of cold feet.

           Peripheral neuropathy is a condition of degeneration of axons of distal nerves causing numbness or perceived coldness to the area once supplied by the nerve. Although common in patients with diabetes, it can also be seen in conditions such as alcoholism, malnutrition, hypothyroidism, and chemotherapy. Vitamin deficiency, such as that of B12 and folate, can cause demyelination of nerves leading to peripheral neuropathy. In addition, iron deficiency anemia, which is an iron deficiency, and therefore hemoglobin production, directly affects the amount of oxygen reaching tissues in the body. Thus, an appropriate amount of blood may not reach the far extremities and toes, causing symptoms of cold toes.

           Hypothyroidism, the 2nd most prevalent endocrine disorder after diabetes, is another culprit of cold feet. Patients unable to create sufficient thyroid hormone cannot thermoregulate their body temperature. Other systemic diseases that can lead to cold feet are hyperlipidemia, which damages and constricts blood flow through inflammation and atherosclerosis of arteries, and diabetes, which causes glycosylation and calcification. Therefore, it is crucial to get regular blood work and follow up with a primary care physician who can provide the appropriate referrals.   

            Symptoms of cold feet, while a cause of normal reaction of the body to decreasing external temperatures, should not be dismissed. They may indicate underlying vascular, systemic, or endocrine diseases that a specialist should further evaluate. Podiatrists are crucial in identifying factors that can lead to cold feet, so a multidisciplinary approach is recommended across multiple subspecialties.

Contributors:

• Jane Pontious, DPM Clinical Professor, Dept. of Podiatric Surgery TUSPM
• Kushkaran Kaur, DPM, MS

1. Kersting, Jonas, et al. "Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD)–Current Data and Perspectives." RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. Vol. 191. No. 04. © Georg Thieme Verlag KG, 2019.
2. Crockett, David, and Daniel Bilsker. "Bringing the feet in from the cold: Thermal biofeedback training of foot-warming in Raynaud's syndrome." Biofeedback and Self-regulation 9 (1984): 431-438.

Podiatrists starting a new practice or continuing to grow an existing one are accepting and seeking new patients.

Marketing to attract new patients is vital. Creating a strategy to attract new patients can be nerve-wracking, especially when dedicating most work hours to patient care and office management.

Marketing agencies may knock on your door, pitching campaigns that sound good. Often the costs seem steep, and you may be uncertain what works. Fortunately, you are a part of an association here to support your career by offering opportunities to network with other podiatrists and obtain relevant news!

Many techniques and strategies could work for you.

Here are three ways to attract new podiatry patients.

1. Create and maintain a robust digital presence.

If you do not already have a website, you will want one. The website should include bios, office hours, contact information, location information, and information about conditions treated.

If you are a podiatrist that does not have your practice, you can still benefit from getting an updated headshot or updating your bio online.

Patients choosing a podiatrist will want to see your face and know a little about you and your qualifications before making an appointment.

2. Get involved in your community.

What opportunities are there to network to get your name out there?

Perhaps you could join your local chamber of commerce. Consider hosting an event and inviting potential referral partners to see your location and learn more about your services.

Consider sponsoring a 5K and distributing literature about your practice.

3. Leverage the opportunity to increase referrals through existing patients and other reputable sources.

Your existing patients can be your most significant source of referrals. Prospective patients often do not seek a podiatrist because they don't know about the treatment of podiatry and conditions. Existing patients aware of the conditions you treat can then refer loved ones to your practice. Ensure your office has adequate signage, brochures, and materials that incorporate all your offerings.

Some podiatrists have found a strategy and a budget that works well for them!

When meeting with an advertising agency, one should ask questions when you are unsure. If you don't know what questions to ask, perhaps you have a friend or mentor, such as another podiatrist or business owner, who can give you some advice!

Keep working hard to get your name out there, and your practice will achieve growth,

PPMA is an association dedicated to the greater good of podiatrists in Pennsylvania. To learn more, visit PPMA at www.ppma.org.