06/08/2015    Jeff Kittay, DPM

The Handwriting on the Wall

As I prepare to close down my office in the next
few months, I can't help but think back on the
past 35 years of practice and look at the pluses
and minuses. I supported a family, managed to
keep myself fed, saved a few dollars, paid my
bills, and helped a few patients along the way. I
also created a unique niche practice much
dependent on immigrant populations with
Medicare/Medicaid insurance, worked at three
community health centers and various elderly
housing complexes, and generally made a practice
that seems suited to no one but me.

With government interference, regulation, and
oversight increasing, along with the attendant
expenses, I should have seen the writing on the
wall much sooner. Sole proprietors like myself
are quickly disappearing from the scene, as new
residency graduates look for hospital positions
or to join groups already established. The costs
of establishing a new solo practice, under the
crushing load of debt that many have, can be
daunting and overwhelming.

Purchasing an existing practice can be a crap
shoot, since most lose nearly 30% of the patient
load within a year or so, and you never know if
the practice you are taking over had been run
according to the standards you have set for
yourself. And it means taking on even more debt,
with no guarantee of a payoff, though you do
start out with some patients and income right
off. I did it thirty-five years ago, taking over
an existing practice from a well-liked
practitioner at a very reasonable cost, and have
few regrets.

I tried to do the same for our next generation,
but the circumstances now are very different from
those in 1980. The responses to my ads in PM were
anemic and led nowhere, again not the fault of
anyone but me. Perhaps it is MY attitude that is
getting in my own way, but that is hard to tell.
As I have told many patients and friends over the
years, who have found themselves in difficult or
unpleasant situations, “When you're up to your
ass in alligators, it's hard to remember that
your initial objective was to drain the swamp.”

I truly wish all the new residency grads well and
hope that wherever they land, that whatever
dreams or wishes they have nourished since
starting podiatry school all those years ago, are
fulfilled and fulfilling.

Jeff Kittay, DPM, Boston, MA

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