12/31/2013    Dan Klein, DPM

Would You Change Occupations if You Could?

Podiatry has been trying to compete
with mainstream medicine, i.e. MDs and DOs and
demonstrate and, at times, demand recognition as
superior in lower extremity expertise and general
medicine.

Unfortunately, until our core instruction,
including residencies for all graduates, becomes
universal and recognized by mainstream medicine,
we will never compete for equality in today's
medicine. Despite efforts to lobby Congress, and
APMA's attempts for recognition, we as a
profession have failed this goal.

Graduates from our schools face empty promises of
residency training, and faced with high debt,
inability to obtain state license and struggling
practices, podiatrist are fighting to survive.
The fact is, as I have proclaimed for years,
podiatrists don't provide a unique service and are
not granted holistic medical privileges due to our
lack of universal residency training and
restricted license.

The military doesn't even classify podiatrist as
medical officers but rather 'allied health'
professionals. The term is still utilized in
hospitals and podiatrists are looked upon with
limited health professionals privileges. Vision
2015, as touted as a drive to help elevate
podiatry recognition, may fall short of
accomplishing desired goals because of lack of
universal, recognized, residency training.

Residency training must be similar or the same as
MD or DO if podiatry is to survive. Residency
training must be comprehensive in general
medicine/surgery and recognized by our colleagues
in mainstream medicine. CMS will only exacerbate
the problem with future limited pay and
requirement for primary doctor certification and
referrals for podiatry services.

Given the opportunity to have chosen a different
path to practice medicine, I would have gone to
traditional medical school and put to rest all the
difficulties I went through both in military and
civilian practice.

Finally, I don't think it was by chance that a few
of our podiatrists have obtained their MD or DO
degrees.

Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com

Other messages in this thread:

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11/01/2014    Stanley R. Kalish, DPM

Would You Change Occupations if You Could? (Robert Kornfeld, DPM)

It was somewhat disconcerting that such a great
percentage of our profession would opt for a
change in their occupation as seen in the recent
PM News survey. However, we might be surprised as
to the statistics of unhappy people in almost any
profession not just podiatry and medicine.

As a participant in the white coat ceremony at
NYCPM a few years ago, I was privileged to hear
many inspirational speeches addressed to the
future doctors. The audience was filled with proud
beaming parents as they saw their children cloaked
in their white jackets. We need to remember that
"The ability to diagnose medically and surgically
is an honor given to a chosen few."

There is no other profession in the world that
creates the instant respect when asked of your
occupation and; you say I am a physician. We must
try to remember this when;we are surrounded by the
negativity of what we perceive has happened to
doctors, the answer is simply nothing has happened
to doctors that can't be changed by "you". If you
are not passionate about your work it will only be
a job that brings home a paycheck.

Change whatever it is that is bothering you about
our profession. How, Stan do we do that? The
answer "one" answer. As Jack Palance said to Billy
Crystal in "City Slickers", It's up to you to
figure out what that one thing is. If you are not
getting paid what you think you should you first
must realize that you must treat worthy patients.
Worthy of your services and whatever that means.

If it's purely money that is your concern than
build a" boutique practice" or accept only
patients with good insurance or cash. Realize your
image may change when you make a purely financial
decision about you profession. There is, however,
another way to look at this. If I get paid well, I
can ecomically treat whom I wish to treat and
treat the rest pro bono. I can then use my
increased revenues and invest in the state of the
art instruments, equipment, implants, and
orthobiologics and get reimbursed for these
improved techniques.

This is only true if I'm making money in my
practice and surgery center.I have found a way to
do this with my free standing surgical center and
a new billing concept.I'm happy to teach this to
all who ask at no charge from me. This method of
billing is a patient advocate process that puts
the power in the hands of you the podiatrist
delivering the service. Ask youselves this
question. Could there be hundreds millions of
dollars made in major league baseball by ticket
sales, TV revenue, banners and hot dogs etc., if
the ball players never showed up to play?

The answer is a simple "NO." Why in medicine do we
perpetually allow the tail to wag the dog? We have
the Hippocratic oath and can't strike: so how can
we defend ourselves and our patients in the"
profit "motivated insurance industry. The answer
is obviously not simple as we enter into the
unknown realm of Obamacare. Change and the fear of
the unknown is an opportunity for some and a
disaster for others. FDR said "We have nothing to
fear but fear itself."

Stanley R. Kalish, DPM, Jonesboro, GA,
srkalish@bellsouth.net

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01/06/2014    R. Alex Dellinger, DPM

Would You Change Occupations if You Could? (Alan Sherman, DPM)

There are many issues facing podiatry, just as
there are many issues facing medicine in general.
This will be my 15th year in practice. My practice
has 4 doctors now,and I do most of the daily
practice managing such as payroll, paying all the
bills, etc. So on top of seeing patients 5 days a
week, I put a lot of hours in related to my
practice.

I typically see patients 8:30 AM to 5 PM Monday
through Friday. I do surgeries on Wednesdays,
starting usually around 7 AM, and after those are
done, I have the rest of that day off. I also stop
seeing patients around 2 PM on Fridays so I have
time for a long weekend, etc. I never am on call.
I rarely get called from surgery patients, thus my
weekends are most always "free". I have a college
friend who is a family practice physician in a
smaller town 2 hours from me. He takes hospital
admissions at the local hospital pretty much every
other weekend, and sees about 50 patients per day
while he's in the clinic. I make twice what he
does. Would I trade with him? No way.

I have a friend who sells plastic for a large
company. He works his tail off, works out of town
trade shows on weekends, and makes sales calls
regionally all week. I remember when he was
ecstatic when he made $125,000 in one year. I
guarantee you he worked more hours than I did that
year, and I made way more than that. I wouldn't
trade with him either. Are there things I would
want to change about podiatry? Sure. But it
provides a very good living. For that I am very
thankful. There are changes coming to medicine,
but podiatry will survive. We do feet and ankles
better than anyone. That won't change.

R. Alex Dellinger, DPM, Little Rock, AR,
raddpm@yahoo.com

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01/02/2014    Judith Rubin, DPM

RE: Would You Change Occupations if You Could?

There are many people who would have loved to be
something else if they had the chance. But, I know
many of you feel like I do. Back in the early
1980s, I felt very special being a 2-year
residency trained surgical podiatrist. I got paid
what I asked and all was good.

We could open up cold and the profession was there
to help you. Now going out on your isn't an option
due to the money. I was always a little rebellious
trying to put myself on par with my MD colleagues.
Being a woman made it harder. We should have
worked harder as a society to get equal pay for
codes used by other physicians.

To this day, we are frustrated that orthopedists
get more money for the same codes. I think we are
all fearful that what it took a lifetime to work
up to will be snatched away by this government.

Make a New Year's pledge with me, please. We will
not testify against each other in court. I see
that and my heart breaks in pieces. It is rare
that MDs do it. After reading that case in New
York where the woman got $800,000 for a fifth toe,
I say no more testifying against our own. PLEASE!
There are other ways to make a living.

We will, as a profession, respect our worth in
medicine and that we cannot be replaced by another
profession. We will work harder to help each other
when we need it. Most of all, we will not let
insurances run our practices.

As a medical profession, we have the right to say
no to lessening payments and increasing
frustrations. This was the most unhappiest
holidays of my life. Let's get better more diverse
AFFORDABLE seminars in all phases of podiatry, and
more often. For the New Year my friends, let's
come together again as a profession and stay the
course because we can't be replace.

And that's a wrap. Happy new year. Let's make 2014
the best podiatric year ever.

Judith Rubin, DPM, Houston, TX, Jrubinfoot@
aol.com.