12/04/2022    Robert Kornfeld, DPM

The Commercialization of Medicine (Ivar Roth, DPM, MPH)

Kudos to Dr. Roth for his direct pay success. I
went direct pay in 2000 and I agree, it was a slow
start. However, with a strong niche, consistent
marketing, a schedule that eliminates waiting time
and rushed appointments as well as being easily
available to speak with patients, you can build a
very low stress, low expense, successful practice.
There are downsides though. You need to
consistently market your services. No one will find
you in a list of participating doctors. You’ll get
many calls from prospective patients who are
interested but once they find out you don’t take
insurance, will not come.

But, it is the epitome of working smart and not
hard. When I dropped insurance, I was up to 60-70
patients a day. I was exhausted and stressed.
Mistakes were made. Omissions were made. A fair
amount of angry patients had to wait in the waiting
room sometimes up to 2 hours. I hated it. Worst of
all, expenses were so high my %age net was dismal.
My only word of caution. I believe now is a good
time to begin positioning yourself for the change
but because of the looming recession, do not expect
lots of interest/traffic too soon.

I have been in a good position for many years
because most of what I do is not covered by
insurance. You must have a STRONG NICHE to make it
work or possess superior expertise to stand out to
those who are willing to pay.

I have consistently opined that the only way to
make health care a great profession again is for
ALL doctors to drop out. Realize without us,
insurance companies have no product to sell. One of
two things would happen. 1) They would have to
create logical reimbursements rates or 2) it would
push the one-payor system into being. But doctors
have cooperated with insurance companies and now
they’ve got you by the b*#”s.

Now, at 68 years old, it doesn’t much matter to me.
I tried for years to get podiatrists on board with
my paradigm and practice model but instead of
growing the sub-specialty of functional medicine
for foot and ankle care, podiatrists who did not
know me or ever bother to learn about what I was
doing attacked me on the internet and turned me
into the NYS Education Dept. for practicing
“dangerous, unproven protocols”. Small minded
people do small minded things. The investigator
that interviewed me actually became a patient of
mine. After suffering with chronic Achilles
tendinitis for 9 years, he was healed and has sent
me many patients over the years. I’m still here in
spite of my “colleagues”.

You can all do what you wish to do. In my 40+ years
of practice, I’ve watched this profession choose
the road of a slow and painful death.

Robert Kornfeld, DPM, ny, ny

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