05/12/2016    Robert Kornfeld, DPM

RE: CMS and the Downfall of Western Civilization (Billie Bondar, DPM)

I have read the recent threads regarding the
end of private solo practice, CMS, and the
downfall of western civilization, etc. It is
patently clear that most of us recognize that
what you must put into a medical practice has
significantly increased and what you get to
take out of it has significantly decreased.

As a 1980 graduate of NYCPM, I have been around
long enough to have seen dramatic changes in
Medicare and health insurance reimbursements.
And these changes have been ongoing for at
least 30 years (the first Medicare fee freeze I
believe was in 1985). Suffice it to say there
has been a spate of new guidelines and
administrative requirements imposed on
practitioners along with enormous cuts in
reimbursements.

Physicians clamber to cooperate with any and
all of these impositions on private practice
for fear of "not getting paid" or "losing
market share" - i.e. your patients will find
the next DPM around the corner. This is my
opinion and should be taken as such, but ALL of
the cooperation doctors give to Medicare and
insurance companies comes from fear.

And it is this fear that has fueled the
cooperative spirit in medicine. And this
cooperative spirit has empowered all of these
ever-increasing regulations and guidelines and
decreased reimbursements to spiral out of
control. In a capitalist system with consistent
inflation, how is it that doctors incomes were
targeted to be lowered? Everywhere I go, prices
consistently rise. When I got my first car, I
paid 24 cents a gallon. Now it's $2.50. Is the
gas any better? Pizza was 15 cents a slice in
my Brooklyn neighborhood. Now it's $2.50. Is
the pizza any better?

The home I grew up in cost my father $12,000.
That same house today would sell for $250,000
at least. So the way I see it, the gas
stations, pizza parlors and real estate
developers have not suffered a net dollar
decrease in income. But we have. And the only
reason this has happened is because doctors let
it happen. Remember Nero? How much more
fiddling are you going to sit by idly and watch
until your ability to earn an income consistent
with your education and commitment burns to the
ground? None of this could have happened if
doctors were not complicit in the process.

Has Congress voted itself a pay cut? We have a
government that earns $10,000 a year and spends
$100,000,000 a year (this is just to make a
point in case anyone gets anal over my
figures). But we are no longer entitled to earn
superior incomes, completely justified by the
level of difficulty it takes to get into
school, earn a degree, get trained in a
residency and then become responsible for the
health and safety of the public.

There's something wrong with this picture. And
it is clearly that the enemy is within. This
happened to us because we let it happen! Anyone
who reads PM News knows that there is a growing
cancer among practitioners and that cancer is
called futility. Yet, futility only really
comes after consistent and repeated attempts
over time lead to failure and exhaustion. It
seems to me that you all just skipped ahead to
futility. If you're going to cooperate, stop
complaining. If you want to see change, stop
cooperating. It can and will get worse until
you stand up and say, "I'm mad as hell and I'm
not going to take it anymore".

Robert Kornfeld, DPM, Port Washington, NY

There are no more messages in this thread.