RE: The Future of Podiatry (Rod Tomczak, DPM, MD, EdD)
From: Robert Kornfeld, DPM
After the thread on The Future of Podiatry, many DPMs emailed me who are disgusted and fed up with insurance-dependency and hate going to work. Yet, most of them said the same thing to me, "My patients will never pay me!" This is testimony to the fact that many of you do not believe your services have any value. And that is the crux of the reason why you all stay in the system and suffer.
The reality is simple. If you accept insurance and your patients have very little out-of-pocket expense when they see you, why would they pay you? You are all correct. Those patients may like you, but the only reason they come to you is because they can come on insurance.
Your current insurance-pay patients are NOT your patient...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
From: Robert Kornfeld, DPM
Here is another "defensive" post which completely misses the point of what I shared. So, Dr. Tomczak, since you dragged me back into this discussion, let me enlighten you as to where I come from. First of all, I did deviate from conventional medicine long ago as I found that functional medicine did a far more reliable job of getting my patients well, especially the chronic pain patients who had been failed by many other doctors. I was so happy with this paradigm that I put a seminar together for our profession to teach what I had already learned. This was back in 2002. I wasn't so upset that they did not go over well and few sought to learn it. What I was more disgusted by was the level of vindictiveness in this profession.
Podiatrists who never met me and had no idea what I was doing for my patients chose to slander me online. Local podiatrists told patients very negative things about me, again, with no clue as to what I was doing in my office. My own NYSPMA also put me in harm's way back then. So I decided to step away from podiatry and...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
From: Robert Kornfeld, DPM
I wholeheartedly disagree with Dr. Udell's damning assessment of direct-pay practice. It is very easy to sit in a defensive posture when you have absolutely no experience with this kind of practice. But take a look around, Dr. Udell. Doctors are already drowning in quicksand. And that is not going to get better. You cannot come from a place of fear when you know damn well that change is needed.
The reality is that continuing to participate (cooperate) with insurance is economic suicide. Right now there are hundreds of MDs and DOs converting to direct-pay. There are also more DPMs than just me who have converted to direct-pay and are happy and thriving. How do they do it? They give patients a compelling reason to pay them directly. There are many ways this can be accomplished. And there are doctors offering courses to assist in this endeavor to free yourself from the rigors of insurance-dependency or PE employment.
The "too late" mentality is akin to failure mentality. If fear of failure is your main motivation, then you will stay stuck and at the mercy of insurance companies. I see life very differently. When I see something I want, I do what I have to do to get it. To be at the mercy of a third-party or corporate employer whose vested interest is in exploiting your knowledge and expertise for their gain is professional suicide. You have it backward, Dr. Udell. Direct-pay is salvation from a place of fear when you know damn well that change is needed.
Robert Kornfeld, DPM, NY, NY
From: Elliot Udell, DPM
Dr. Kornfeld has been a long-time critic of how medicine, including podiatry, dug its graves by getting involved with insurance companies. He is correct. If podiatrists could free themselves from dependence on insurance companies, doctors would be making more money with less hassles. The problem is that telling our entire profession to separate itself from the insurance industry is akin to telling someone drowning in quicksand that he should not have hiked in the woods. It's too late!
Dr. Kornfeld has a special niche practice and may be able to get away with running a cash-only practice because he does not have competition. For most doctors who practice in an increasingly competitive environment, telling patients that they can only be seen if they present "greenbacks" as full payment is akin to telling those doctors to commit economic suicide. Dr. Kornfeld is correct but the medical profession is too late.
Elliot Udell, DPM, Hicksville, NY
