06/19/2015    Cosimo Ricciardi, DPM

Independent Practice is Dead (Joseph Borreggine, DPM)

I read with great interest the sentiments and
analysis of the profession detailed by Dr.
Borreggine and others regarding the challenges we
face as a profession. Salient, no doubt,
describing a side of the story which, quite
frankly I am sick of hearing. Comparisons are
made in terms of sweeping generalities using “we
as a profession” as if we all adhere and are
bound by the same analysis of despair.

Yes, podiatry is faced with challenges. We are
doctors in a never ending cycle of change and
rebalance. A cycle which has continually morphed
into a new challenge and a new way to see the
current situation in podiatric medicine as griped
in an unsolvable morass. Problems which are
shared in the majority of instances by our
medical colleagues.

Yes, I agree our professional institutions are
not doing what I, and many of my colleagues feel
needs to be done to best serve the profession.
Must I remind the reader which national
organization is most vocal in the push to
universal coverage, EHR and ICD10 transition? It
was not the APMA. Our allopathic colleagues face
the same problems with their professional
associations if not worse.

Yes, employment in a larger group has appeal.
However, I speak very often with younger and
seasoned podiatrists who would not think of
trading the liberty of self -determination of
their practice or partnership for the security of
employment at the will of another entity. I’ve
seen physicians, both podiatric and allopathic
who have joined large groups, multispecialty
groups and hospital employment only to be “fired”
in lieu of a less expensive replacement.

Yes, there are health care providers who are
rendering foot care. They are also some who are
rendering general medical care, cardiac care,
emergency care, and all matters of health care
delivery. Its medicine.

Our fight is in providing care above the
standard, above the bar and exceeding patient
expectations consistently. Proving yourself the
expert, again and again, not just calling
yourself one.

The barbarian at the gate has been there my
entire career: Residency shortage, Declining
reimbursement, increased competition, regulatory
issues, rising malpractice, MD/DO designation, on
and on and on, the same song over and over for my
15 years. The fight is not against the barbarian
at the gate but against apathy, inaction and
focus on the external at the expense of the
internal, significantly more changeable.
By no means whatsoever do I diminish the
significant hurdles we face. Nor do I disregard
the points made by others. Someone, however, must
speak the balance.

I look around and I see a plethora of bright,
talented, young podiatrists as the go to provider
for pathologies 20 years ago we couldn’t touch,
holding positions of importance of which an older
generation dreamed. Eighty percent of our
profession practice in groups of 3 or more. Large
multi-office practices are flourishing and
podiatry is consistently ranked in the top
professions. Napoleon Hill said that you are the
average of the 5 people with whom you spend the
most time. I acknowledge the barbarian at the
gate, but I refuse to hang out with it.

Cosimo Ricciardi, DPM, Crestview, FL

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06/19/2015    Robert D. Phillips, DPM

Independent Practice is Dead (Joseph Borreggine, DPM)

I read with interest the comments by Dr. Joseph
Borreggine. Unfortunately, I feel that he is
equating podiatric practice with private
podiatric practice. As a teacher in the College
of Medicine at the University of Central Florida,
and also a teacher in the family practice
residency of a local hospital, I can say that the
golden age of medicine is over.

Medical students are incurring ever increasing
debt in going to school and struggling to pay off
that debt afterwards. Insurance companies have
almost totally interjected themselves in what
used to be the doctor-patient relationship –
which included both the medical relationship as
well as the financial relationship. Ever more
time is being wasted in administration of
medicine instead of learning and practicing
medicine.

More podiatric physicians seem to be interested
in the proper coding for a bunion surgery than in
selecting the right bunion surgery for the right
patient. More time is spent in filling out EMR
records than in actually laying hands on patients
and in educating patients. Anyone who interviews
medical (or podiatry) school applicants knows
that the number one answer, when asked why they
want to go into medicine (or podiatry), is
“Because I want to help people.” At the end of
the grueling debt ridden roller-coaster
schooling, the new physician is often asking
themselves, “Why did I go into medicine?”

Salaried positions are becoming ever more popular
with physicians of all specialties, to alleviate
some of the stress of the burden of the huge
debt.

With record numbers of private practice MDs and
DOs also selling their business to work for
salary for large corporate health institutions,
podiatric physicians are caught in the same bind.
This is not a fight of podiatry against big
medicine, as Dr. Borreggine would have us
believe, it is a fight for survival by all
practitioners of medicine.

The survival of podiatry as a specialty really
depends on our ability to penetrate these huge
multispecialty health institutions. Podiatry is
much more acceptable by medicine when our other
specialist colleagues have daily interaction and
are sharing patient responsibilities. It becomes
financially beneficial then to include the
podiatrist, not exclude him/her. I hope to see
many more podiatric physicians join with our MD
and DO partners in the new medical institutions
and not try to go it alone.

Robert D. Phillips, DPM, Orlando, FL