05/09/2022    Robert Kornfeld, DPM

What would you recommend as a career for your child?

I have been a podiatrist for more than 40 years.
My children are all in their 30s and none chose
podiatry (or any medical specialty) as a career. I
am very happy about that. For 40 years, podiatry
has failed to achieve parity. While we were busy
becoming better surgeons so we could feel more
like “real” doctors, medicine collapsed and burned
in a series of increasingly restrictive payment
guidelines from Medicare and insurance companies.

Doctors have surrendered the standard of care to
them. They’re payment model is a mathematical
algorithm designed to minimize payment to doctors.
Do not fool yourselves. It is NOT a healthcare
algorithm. All the “experimental” and “not
medically necessary” denials are nothing more than
payment prevention tactics. The irony is they only
have all this power because most doctors still
participate and yet this is why so many doctors
hate medicine.

Although I quit the insurance model more than 20
years ago and switched to direct pay (a thousand
times less stress and I truly love my practice and
my practice model), the public is still
conditioned to not pay out-of-pocket for their
care. In my opinion, it is one of the worst
professions to get into now. And going downhill at
an alarming rate.

I am approaching the end of my career as a
podiatrist. I never have issues with insurance
companies regarding payment anymore. And for that
I’m grateful. My stress comes only from other
podiatrists who, with absolutely no knowledge or
experience with functional medicine and through
small-minded thinking, have criticized what I do
and caused me a number of times to defend what I
do to the State Education Dept. I have worked
closely since 1987 with MDs and DOs who follow the
paradigm that I do and can say that I consider
them my brethren and have developed stimulating
and highly educating relationships with these men
and women. That is what I will cherish the most
about my career.

Podiatry has failed to grow in this approach to
patient care. I know I am one of only a handful of
podiatrists who understand and utilize functional
medicine. My enormous amount of experience and
expertise will not be transmitted to you because
it has been rejected as “experimental” and “not
medically necessary” by this profession. Yet, I
have healed literally thousands of patients that
mainstream medicine/podiatry failed to help. And
NOT by surgery. The singular focus on surgical
residencies, IMO, is the BIGGEST mistake this
profession has made. The second biggest is the
almost universal rejection of functional medicine.
And that will be the final downfall of podiatry.

Robert Kornfeld, DPM, NY, NY

Other messages in this thread:

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05/13/2022    Paul Kesselman, DPM

What would you recommend as a career for your child? (Allen Jacobs, DPM)

I am one of three podiatrists in my large extended
family along with many other MD specialists. Of
all the podiatrists in my family all of my
generation, none have children who went into
podiatry or medicine. As for all my relatives who
are MD specialists (there are at least 9 in my
generation, only one has two of four children who
went into medicine.

There are two MD couples, neither of whom have
children who went into medicine with one of the MD
couples being involved as chair of a department at
a large tertiary care hospital. As for my
undergraduate and earlier schoolmates, none of
those who went into any form of medicine have
children who went into medicine.

I do have one relative whose child went into
veterinary medicine, which cost her a fortune.
While she is happy with her career choice she
realizes it was an economic disaster for which she
will have to work many years to recover from.

One podiatry school classmate has a son who is a
PA and another who is a research pharmacist. I
consider their choices to have been the smartest
choices as they have secure employment with
guaranteed financial futures.

Would I have done podiatry again? Likely no, But
back in the early 80s or before when many of us
started, we were able to practice independently as
many MD/DO. And as Dr. Jacob's noted, our parity
was based on our patient outcomes. To a large
degree it still is and no legal parity is going to
change whether your MD/DO colleagues continue to
refer to you. That really is no different than any
other small business. Your success is based on
what services you deliver and the quality of those
services. And that is all on you, just as it is
when you choose to consult with an MD/DO for your
patients or yourself.

My biggest fear as we all age is our need for
physicians for ourselves and our family members.
Many of my physicians are now doing what most of
my generation are doing, retiring or becoming lost
in the shuffle of institutional large practices.
Unfortunately a few have passed onto the great
beyond.

So it appears that medicine has become big
business and just as we need to cherish
connections with business people in other areas of
our lives, we need to cherish the same
relationships with others. The DPM of the future
whether an MD or DO or still DPM will nevertheless
still be a part of a big business picture. For the
newbies they will never have experienced practice
as we did and in some respects it will be easier
for them, because they did not have what we had.
I'm not sure if there are any positive solutions
to this issue, but hearing the same stories from
MD/DO apparently makes DPM have parity, at least
when it comes to the future.

Paul Kesselman, DPM, Oceanside, NY

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05/13/2022    David E. Samuel, DPM

What would you recommend as a career for your child? (Allen Jacobs, DPM)

On target once again Dr. Jacobs. Making a good
living is one thing. Daily fighting with insurance
companies, etc. can suck the life out of you. What
we do is rewarding. The daily grind to achieve
that and make a solid living gets worse. For my 3
boys, there is absolutely a better way to make a
living than the energy expended on non-patient
care. I would not recommend unless this was
something they absolutely were hard fast and
committed to medicine and then if would be
allopathic for sure. None have chosen medicine,
although one took his pre-med degree and decided
on device sales and is/will continue to do quite
well.

The parity thing is funny. Parity how? I don’t
feel any less than any of the doctors I work with
and who refer to us. We have mutual respect and
work together for our patients’ well-being. This I
am quite happy with and I agree with Dr. Jacobs, I
have parity here. Let’s talk REAL parity. Where it
really counts. Stop with the, “I’d do this no
matter what” stuff. I wonder how many PA
podiatrists, and I will bet other states, know
that we get 25% LESS if not more, than ANY
ORTHOPOD, or Pod working in an Ortho group, doing
and billing the EXACT SAME CODES? Where is and has
been the APMA/PPMA on this over the 30 years I’ve
paid my dues?

I’m on the back nine of practice. How I would have
loved to get paid equally over all these years. To
me, I think it is inexcusable to not have made
this the highest of priorities to “legislate”
equal pay for equal work. Isn’t that only fair?
How many PA pods have screamed about this over the
years, or is this something that is not known by
the majority ? I was speaking with a colleague the
other day and they had no idea. Is this not known
by the majority of us?

I have no idea about other states, but I would
suggest others, especially younger docs look into
this, as to not end up looking back at 30 years of
practice, doing great work, and getting paid
significantly less than the ortho doc down the
street, that hasn’t seen a foot besides their own
in 10 years. This includes common ankle
procedures, like a simple fibular fractures, scope
etc. 25% LESS or MORE. Parity starts here.

David E. Samuel, DPM, Springfield, PA