04/23/2024     Allen M. Jacobs, DPM

The Future of Podiatry - PART 2

As we move forward (I should say you, as I'm on the
18th green and putting out) there must be a
realistic examination of the future of medicine. As
corporations and healthcare institutions continue
to take over medical care, and insurers evaluate
our care, the bottom line is cost effectiveness.
This is a major reason why NPs and PAs are
replacing MD's and DO's an independent healthcare
providers. This is a driving force for pharmacists
beginning to provide healthcare. It is a driving
force for urgent care centers replacing emergency
departments, surgical centers providing services,
we can site example after example.

Ultimately, insurance carriers want the least
expensive medicine provided, whether it be testing,
office fees, drug choice, procedure selection.
Industry, such as corporate driven medicine, to the
contrary, wants you for profit. You are evaluated
by industry first and foremost by the profit you
generate. The conflict between industry and payor (
and your personal desire to maintain a profitable
practice) creates a conflict that ultimately makes
you the proverbial sacrificial lamb. You are damned
if you do, damned if you don't.

Patients already blame doctors for increasing
copays and deductibles and uncovered services.
These problems will continue to increase into the
future. As a practitioner, you will have to
determine the appropriate path to follow. Does a
patient require an expensive non-generic medication
when a generic medication would be expected to
provide the same result without increased risk?
Does a patient require expensive fixation for
osteotomies or arthrodesis procedures when these
devices provide to proven and published advantage
in healing? Do all postural complaints or concerns
require formalized orthotics as opposed to
prefabricated supports? Do all ankle sprains
require a CAM walker boot Do the majority of
wounds require expensive wound care products?

The goal of industry is first and foremost profit.
As Sir William Osler noted over 100 years ago,
although you entered medicine to make a living,
this should at all times be a secondary
consideration. Industry driven considerations and
corporate-driven medicine as your employer
encourage more expensive medicine. The
retrospective studies on this subject are clear.
The loser is not only the patient. It is you. If
you cost too much, providers may eliminate you as a
provider. If you fail to make an adequate profit,
your employer may eliminate you. Remember, what is
legal may not be ethical, and what is ethical may
not be legal.

Today's podiatry college graduate is entering a
difficult world in which to practice. A common
denominator is the influence of industry on your
decision making for podiatry care. To borrow from
Sir William Osler, do not become enslaved by
industry created pseudoscience. When you cost more
for the same or similar service, without proven
benefit to a patient, you are adversarial to the
interest of the insurer, as well as your profit
first employer. When new technology is introduced,
the first question Dr. Jack Schuberth always asks
"exactly what is the problem that you are solving?"

Frequently, solutions in search of a problem are
expensive. Ethical behavior includes not only your
interactions with the patient, but also your
interaction with follow podiatrists and the
profession as a whole. Included in these
interactions are truthful and scientifically based
(ie: legitimately studied and published)
endorsements of new pharmaceuticals, techniques,
and devices. 510K approval means nothing.

Your survival in practice as well as ethical care
of patients and your responsibility to society
demand cost-effective care. To do otherwise will
decrease your value to patient and provider and
employer, and could endanger your future.

Allen M. Jacobs, DPM

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