08/25/2022    Paul Kesselman, DPM

NC Podiatrist Owes $895K in Student Debt (Michael M. Rosenblatt DPM)

I have to agree with Dr. Rosenblatt and disagree
with Dr. Chaskin's use of the word "fiduciary". Dr.
Rosenblatt's reference to his experiences rang a
familiar ear to me as I too was headed towards a
musical career. However, I too realized that either
you were one of tens of thousands of gifted
musicians who would be working or traveling when
your families were home, poor or if you were one in
a million would become famous. There are avocations
such as music and art where most people do not
become famous or financially secure. And there are
vocations where most people do become financially
secure. Thus I made the choice to pursue a career
in healthcare. That is the key word, I made a
choice.

Dr. Rosenblatt is also absolutely correct, no
institution can guarantee you anything in life and
you as an individual have to make a choice. Even
those who graduate from medical or osteopathic
school are not guaranteed they will obtain a
residency, certainly not in their first or even
secondary specialty field of choice.

As for the use of the word fiduciary, that is a
legal term and I am not sure if that is appropriate
here.

No more so than Juilliard or any liberal arts
school has any responsibility to provide students
with guarantees of a promising successful career.
If that were the case, every cabdriver,
waiter/waitress in NYC who are aspiring actors,
artists, etc. would have a legal case against the
institutions which they had attended.
Or is that more on the student and their family to
investigate and ask some hard questions at their
interviews and do the required research on their
own?

Perhaps this specific student also has some
responsibilities for this lofty student loan. We
have no idea what their loans were in undergraduate
or other graduate programs prior to podiatry.

Let us also not forget that the school's job is to
provide an education, which they do. Is it the
institution's fault if the student does poorly
academically, has poor hand eye coordination and
does not perform well in labs or performing
surgical techniques? Is not a team player and
performs poorly on externships and residency
interviews or if successful at all of those, fails
their boards multiple times?Those certainly are
reasons beyond the responsibility of the school.

Perhaps Dr. Chaskin meant to say the schools have a
moral responsibility to provide students with what
happens after they successfully navigate their four
years of undergraduate podiatric medical education
and provide them with the realities of post
graduate employment data, etc. That I would agree
on. But again that guarantees the student nothing.

I remember having traveled to Chicago more than 45
years ago this week to begin attending ICPM. I knew
at that time that not every graduate would get a
residency, but I also knew many DPMs at the time
were financially secure. Thus I did my homework,
asking those difficult questions at interviews and
of established podiatrists at the time. Every
student attending any educational institution
should be doing their homework as well, in advance
of signing any agreement to attend any educational
program.

Perhaps I too have been using the term "fiduciary"
incorrectly. Perhaps it would be best for those
legal scholars and I know they are out there
reading this, who can provide us with a better
interpretation of fiduciary and let us know if that
term really does apply here. From my limited legal
knowledge, I do not believe it does.

Paul Kesselman, DPM, Oceanside, NY

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08/25/2022    Robert Kornfeld, DPM

NC Podiatrist Owes $895K in Student Debt (Michael M. Rosenblatt DPM)

Comparing podiatry to music does not address the
problem of high student debt and potentially low
income. I graduated NYCPM 42 years ago. When I went
into private practice, podiatry was a very
lucrative field. We worked hard but we were paid
very well. And our student debt was not even close
to overwhelming or insurmountable. The problem is
that in the early ‘90s, insurance companies created
managed care (managed fees) and our then leadership
pushed very hard to get podiatry covered under
these plans.

Now, this many years later, tuitions have risen
dramatically, managed care’s fees are a fraction of
what they once were and podiatrists still do not
have parity with MDs and DOs. To run a practice,
you must see an enormous amount of patients, which
means large staff and skyrocketing expenses. This
is completely unacceptable.

I mourn the loss of my early days in practice where
my income soared to very respectable levels very
quickly and continued to rise every year. I was
making an enormous income and worked hard to
satisfy my patients and build my reputation. My
practice grew until I began joining insurance
panels and my income leveled off and eventually
began falling slowly after 20 years in practice.
Those of us who got sick and tired of working like
dogs for low pay left the insurance game to work
smart, not hard. Direct pay is challenging in
different ways but it lowers the stress level
dramatically. I am now working 20 hours/week.

I see 1/10 the amount of patients I used to see and
my net income has only dropped 20%. That said, in
my honest opinion (and I have an enormous amount of
experience in podiatry and I’m still practicing),
this is NOT a viable profession any longer. Unless
something changes in a big way, explain to me why
anyone would put in 4 years of college, 4 years of
podiatry school, 3 years of residency and ongoing
CME requirements every year to become a podiatrist
and struggle to pay their bills? This system is
terribly broken and yet new podiatry schools keep
opening up. There’s no question in my mind that
these schools are now marketing a myth to
prospective students so they can fill their classes
and collect huge tuitions. The bubble is bursting
all around us. The glory days of being a doctor are
long over. The future holds no promise of
improvement. And that, quite sadly, is the absolute
truth.

Robert Kornfeld, DPM, NY, NY