Generally speaking, podiatrists, like most
doctors, care very much about the welfare of their
patients and will do what it takes to follow the
Hippocratic Oath in every way. Even if it means
working too many hours, accepting less
remuneration, etc.
The biggest challenge is navigating the ever-
increasing amount of change in every aspect of
daily practice. The regulatory agencies that
govern our scope of practice, coupled with the
massive changes in the health insurance agency
industry including cutbacks to doctors and payment
hikes to patients… makes it literally impossible
to sustain the same income level as each previous
year, while doing the same amount of work and
working the same amount of hours. Thus, every
doctor who has hit his practice max with patient
and hours per day, can't help but lose money each
year.
The number of insurances that doctors will accept
has dwindled and the patient pool has, therefore,
decreased. All this, coupled with a poor economic
climate, creates very difficult times for an
experienced doctor and near impossible times for
the new graduate facing $200,000 or more in school
loans. Start-up costs for a private practice are
spiraling upward. The cost of malpractice
insurance, family health insurance, office
overhead (rent, electric, employee salaries,
phone, supplies, etc.) continually rise.
The starting salary for a new graduate, who
anticipates working a 60-hour work week, after 4
years of medical school and mandatory 2-year post
training, is at best $100,000…along with a likely
HEAP OF LOANS TO PAY OFF. Perhaps, the young
doctor is newly married and has all the normal
aspirations of saving for a home, planning a
family and living a good life. It seems almost
impossible for a new doc to make ends meet until
he's in his forties!
Sadly, the tide is not turning. Socialization of
medicine seems inevitable, and the government will
have hired doctors treat patients in a controlled
environment…seems extreme, but likely, unless
doctors band together and seek a plausible path.
The Trial Lawyers Association has the insurance
companies in their pockets so, for now, tort
reform seems like it will be on the side burner,
and doctors will have to practice very defensive
medicine.
To add to all this, now the government owns the
EHR (Electronic Health Records), which will be
fully mandated in 2014. If a doctor wants to
accept insurance, he MUST abide with every
governmental regulation and document each and
every patient along with a portal for government
to gain entrance into our system whenever they
please!! Now, more than ever, it seems essential
that we all are well-versed in
technology/computerization. I know with all that
is on our plates, having the inclination or time
for this is hard to face.
Some of us believe the bubble will never burst,
but I think the bubble has already ruptured.
Speaking from my own experience, I must get to my
office by 7:00 am, do at least an hour of
necessary computer work before my patient load
begins at 8:00 am and lasting to at least 7:00 pm.
Then, do another end-of-day computer task for an
additional hour or so just to make enough revenue
for it all to be worthwhile. I consider myself
fortunate that I have a very busy practice and my
extraordinary love for what I do propels me to
continuously learn everything necessary about EHR,
new surgical techniques, new doctor technology-
laser, practice business essentials, etc.
But, take away one piece of the puzzle and doctors
are relegated to reduced income or failure. Many
older doctors are saying "to heck with it" and
retiring early. Many younger docs are returning to
teaching, pharmacy or the like. Those in the
middle are either determined to work smarter and
grow their practices or become weaker and die off.
This is the reality of our profession.
I would hate to see a brain drain of younger docs
going to different fields or even different
countries to apply their talents!! Already, other
countries, India for example, are offering newly
graduated podiatrists 3-4 year contracts with loan
forgiveness, housing and a very competitive
salary.
So, now some doctors are forming "Supergroups" in
an attempt to consolidate expenses and house
numerous doctors in the same specialty in nearby
locations under one organizational name…kind of a
mini HMO of the same specialty. Who knows, it
might work. To do this successfully, we must have
business acumen that takes us away from focusing
solely and completely on the field we love and
have a gift for.
The challenges I have cited are universal for all
specialties. The NY Times recently featured an
article entitled Doctors Are Going Broke. So, it
seems evident that we all must continue to
proactively assess new ideas and ways of doing
things in order to survive in our beloved
profession. Darwin-esque or Survival of the
Fittest? Maybe that’s the best way to clean house.
I’m an optimist and KNOW there are solutions, but
it will take individual self-reflection, focus on
our practices from a business and medical
perspective and a concerted effort of many. What
do you think?
Howard Dinowitz, DPM, Brooklyn, NY,
drdinowitz@verizon.net
