09/22/2022    Brian Kashan, DPM

Time for a Strike by Doctors? (Bret Ribotsky, DPM)

I am strongly in favor of a strike by all
physicians. Unfortunately, the world has changed
and not all physicians have the same issues as
others. Those of us in private practice are the
ones who are dealing with the overregulation by the
government, insurance company policies, and
financial pressures. Today, our profession has been
divided into hospital/institutional-based docs and
private practice docs. Any attempt at a strike
would most likely fail, as unless there was a total
strike, the effects would be limited. Teacher
strikes, railroad strikes, etc., seem to carry more
weight and fear than a doctor strike would.

The public sees doctors as rich, spoiled brats.
What do we have to complain about? We can't
empathize with them at all. We are all rich and
play golf on Wednesdays.

Getting people to understand and feel our plight
would be very difficult. HOWEVER, this should not
preclude us from informing our patients, and the
public at large, about all of the things that
plague us on a daily basis. The burden of MIPS, fee
reductions, regulations, and running a business has
forced many to retire early. Recently, in
Baltimore, Johns Hopkins Hospital has threatened to
not accept CareFirst BSBS insurance any longer due
to a poor reimbursement fee schedule. HOORAY!
Someone finally took action and has said no more to
Goliath! As individuals, many of us cannot afford
to do this with such a large carrier. Johns Hopkins
may be pulling the plug on CareFirst, but more
importantly, in my opinion, has shed light on the
ridiculous fee schedule CareFirst pays its
providers, while raising customer premiums every
year. Now, maybe people will actually realize that
doctors are being paid at very low levels, and it
is the insurance companies that are making out well
in this environment.

So, while I do support a strike, and would love the
publicity of it, I do not feel it would do much,
and may actually hurt us. I am in favor of joining
other physicians and health care providers in
fighting a legal battle, taking actions against our
adversaries, and getting our government
representatives to actually represent us and work
with us in improving a rapidly declining system
that is fraught with huge challenges in the future.

Brian Kashan, DPM, Baltimore, MD

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09/23/2022    Chris Robertozzi, DPM

Time for a Strike by Doctors? (Bret Ribotsky, DPM)

At the 2022 APMA House of Delegates, the New Jersey
Podiatric Medical Society submitted a Policy
Proposition to form a health care alliance with all
national organizations that deal with health care.
It passed without a single dissenting vote. That
is not just physicians, but hospitals, hospice,
nursing homes, assisted living, physical therapy,
occupational therapy, etc. There has never been an
alliance of all of health care. Our working alone
all these years has allowed us to be taken
advantage of. There is strength in numbers. It
has always been that different national
organizations lobby for their particular issue in
DC, but health care has never spoken as one voice.
We have more in common than we do differences.

When Obamacare was in its developmental stages, the
American Public Health Association volunteered to
help with health care’s restructuring. They were
told that their help wasn’t needed. The American
Medical Association (AMA) lobbied for different
issues during the creation of Obamacare. They were
completely ignored. One of the issues that they
lobbied for was tort reform for malpractice. That
wasn’t given one sentence of attention in the two
thousand plus pages of the Accountable Care Act. A
great book about the formation of Obamacare, the
players, the backroom deals, yes, all the dirt is
America’s Bitter Pill by Steven Brill. Once you
start reading it, you won’t be able to put it down.

Once the group is formed, it will approach
President Biden to put together a committee to
reform health care. President Biden will know that
we are serious if we call come together as health
care has never united in the past. There will be a
public relations campaign to inform the public why
we formed and that we have approached President
Biden to assist with health care reform. Also at
the table must be the insurance companies and
representatives from the multitude of minority
groups and the general public. As you know, there
has never been a successful fix to the health care
crisis when everyone is not at the table.

We need to understand each other’s issues and find
a solution that works for everyone. The common
goal should be to make America’s health care the
best in the world. That will only happen if
everyone leaves the table a winner. Yes,
unfortunately, we have a long way to go to get
there. Solutions are out there that have not been
considered because the players have not been
directly involved with health care and don’t know
how the system works. For instance, there are all
types of residency clinics throughout the country.
The residents are funded through the government
already. We should be taking advantage of those
clinics for those who have no insurance and
preventing them from winding up in the emergency
rooms with life threating problems. However,
getting the patients to a primary care clinic to
make sure they are healthy and stay healthy has
never been considered.

There is no question about it, this is not going to
be easy or quick. My guess is that it will take
several years from its start to implementation.
Like all of you, I have several ideas that will
make health care better and alleviate much of the
unneeded paperwork. We do have something in common
with the insurance companies. In reading multiple
books on Obamacare and health care in general, they
all talk about overutilization by doctors. Then
they discuss the reason why doctors overutilize,
malpractice. Brill quotes $70 billion, yes billion
dollars, are spent annually due to tests and
procedures being run so doctors can protect
themselves. If the insurance companies didn’t have
to pay for all those tests and procedures, everyone
in healthcare could get a nice raise. Tort reform
is the way that I am told that malpractice must be
fixed. The trial attorneys put up a lot of money
and shut down the AMA lobbying during Obamacare
formation. Once again, there is strength in
numbers. If health care partners with the
insurance companies, perhaps some positive movement
can be seen. I can’t help but believe there is
another way that just hasn’t been thought of yet.
Like many other things, it’s probably very simple
and obvious, hidden in plain sight.

The bottom line is that your leaders are doing
something about this issue. The APMA Board
members, like the board members of the various
colleges and certifying boards practice podiatry
like us. They are struggling like us and feel our
pain. We must work together. At my various
hospital meetings, I hear every specialty
struggling with paperwork, denials and decrease in
reimbursement like we are finding. The time is
right for health care to unite. Without the health
care providers, there is no healthcare system.
Albert Einstein said it best. “In the middle of
difficulty lies opportunity.”

Chris Robertozzi, DPM, Newton, NJ