09/04/2015    Jeff Kittay, DPM

The future of Podiatry (Dan Klein, DPM)

I must, very reluctantly, agree with Dr. Klein's
prediction. Upon graduation from NYCPM in 1979, I
made the fatal mistake of agreeing to see
Medicare and Medicaid patients and accepting
assignment of benefits from them and every
insurance company I could find. Of course, my
first mistake was moving to Massachusetts where
participation with insurance plans is virtually
mandatory, and has been for decades. Because of
the rules written here, if a patient sees a
doctor who is not in their plan, even before the
plague of HMOs, they were and are not eligible
for reimbursement of any kind.

It is not realistic to think that patients will
pay for health insurance and then additionally
pay you out of pocket for services they think
they can get elsewhere for much less, or free.
That the level of such care may be far below what
you offer is not relevant to most patients, cost
is.

As we squabble over whether we are "Kings of
Orthotics" or not, the grand exalted poobahs in
the APMA and affiliated national associations are
presiding over the gradual demise of a great
profession, while earning rather substantial
salaries to do so.

When HMOs reared their rather hideous heads in
the early 1980s, I foolishly thought that no one
with any common sense will tolerate this kind of
healthcare for very long, what with gatekeepers
and accountants running the show. Too bad I
didn't invest in those very HMOs that I ridiculed
those 30-some years ago.

So new residency grads, look to the large
established groups, the armed services, or
hospitals for employment, because that is where
you will find work, stability of income, and
security, no small things in this economy. You
have excellent, hard-won skills that should be
used to benefit your patients for years to come,
but please remember that no practice in the world
is worth a year's gross, no matter what the
"experts" tell you, and that no bank will lend
you that much money, because they know that
that's the truth.

Jeff Kittay, DPM, Boston, MA

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