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01/03/2014 Alan Sherman, DPM
Would You Change Occupations if You Could?
So what are we to make of the PM News poll results of 925 of our colleagues indicating 55% would change professions if they could, and another 15% might ? Are these doctors that unhappy with their profession? Are they really that dissatisfied? I must admit, I was shocked to see these polls results unfolding and have shared quite a few thoughts on what they might mean with my colleagues. I wanted to see a few responses from readers before chiming in with my thought… The United States was the first country to state that every man has a right to the pursuit of happiness and promising it to its citizens. Note that the Declaration of Independence didn't purport to guarantee happiness...only the right to pursue it. The idea had its origins in the oppressive monarchies of Europe, in the writings of political philosophers Jean-Jacques Rousseau and John Locke. Happiness is a lofty ideal. Satisfaction seems a more conservative goal. But does this poll tell us that, as a profession, we are neither? First of all, I like an anonymous one question poll as a way to collect a consensus, but I have to acknowledge that clicking a box is a very low commitment way to complain. I suspect there is some bias in an anonymous survey, in that the passive aggressive among us, that would never complain to friends, colleagues or family, will lash out anonymously in a survey response. I suspect that many answered yes because it felt so good to consider, if only for a second, what could be.
The infinite future of endless possibilities, that abstract thought, tends to seem better than the stark reality of the real here and now. Even if we trained for years for that reality and perhaps used to love it. We know there is dissatisfaction among all doctors, but of course, there is also satisfaction. If you asked them, do you get gratification from your work with patients, I think most would say yes. And of course, the survey begs the questions What else are you qualified to do ? What other career would you like to change to ? The ever thoughtful Dan Klein opines that dissatisfaction should be considered in comparison to other professionals and points out correctly that we podiatrists overlap services with many other medical specialists. I've observed that many of the services that we were uniquely known for like shoe padding and modification, and palliative care, have been abandoned by us for higher paid services. Imagine how the orthopods, dermatologists and infectious disease docs felt when we were invading their turf ? They have been fighting back ever since. Such are the realities of a competitive marketplace. Judith Rubin makes an elegant plea to us to stop testifying against each other in court. That’s a kind thought, but I believe in courts and think that policing strengthens the standard of a profession, as perverse as the process tends to be. Jim Fisher points out that his ER doc brother is unhappy due to all the heart wrenching human drama he sees, but continues working because he likes the $10,000/wk he makes. I understand that. The country medical examiner might also agree. Brian Kiel cites stats that in a Time magazine poll, 2/3 of U.S. physicians were dissatisfied. This is no surprise to us...all of my physician friends feel their satisfaction has declined, but honestly, they are all still getting some satisfaction from their practices and earning a living. Jack Reingold, my old friend from CCPM is happy with his life. I believe it and am happy for him. I wish we could all be appreciators like him. What do we all hope to get from our profession ? We’d like to earn a living, to make money - we'd all like to make more, and in our upwardly mobile society, it’s just hard to earn less after you've made more. We’d like to earn respect from our years of hard work. But it’s become increasingly difficult for patients to admire us, when we are working for their insurance companies, and our interests are so often diametrically opposed to theirs. They want to get as much care as possible, first, and to get the best care, second, and they don’t often know how to judge the latter, so they seek the former. We always seem to be obstructing their efforts to get more care. We’d also like to be a part of a well engineered system of medical delivery in which all party’s needs are being met. Unfortunately, we’re in the midst of the most dysfunctional, poorly executed rollout of a national healthcare system the world has yet seen. Yes, it was tumultuous when the current national healthcare systems were rolled out in Western Europe and the Far East in the 90s. But we’re making those roll outs look like clock work with this debacle. It looks to me like it will take years before this system is working well. My advice to all is to try to take as much satisfaction from it as you can, while earning as good a living as your can. And try to be happy. You did earn it. And I will close with that thought… Alan Sherman, DPM, CEO, PRESENT e-Learning Systems asherman@presentelearning.com
Other messages in this thread:
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
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
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.
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
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