05/06/2024    Robert Kornfeld, DPM

The Future of Podiatry (Rod Tomczak, DPM, MD, EdD

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 do my own thing. I was
invited to speak at a few seminars and conventions,
but that was short lived. And I went along happily
enjoying my practice and helping patients that were
continually failed by conventional methods without
stress and $0 accounts receivable.

About 2 years ago, I began getting lots (and I mean
lots) of emails from podiatrists who were burnt out
by the system, disgusted with the meager payments
and huge administrative hassles from insurance and
were basically at their wits end and were asking me
for help. And why would that be, Dr. Tomczak?
Because they took an oath to do no harm? Because
they took an oath to help to the best of their
abilities? Because they weren't trained well? No.
It is because whether you wish to admit it or not,
podiatry, like all medical specialties, is a
business. And when the business cannot pay the
bills, altruism goes by the wayside. This is the
reality that today's podiatrists are dealing with.
And as long as you allow insurance companies to be
in charge, they will continue to exploit you. And
you will have nothing to fall back on but your
altruism.

As for the comment by Dr. Roth (which I second)
regarding being a better doctor, that is absolutely
my experience. Your insecurity caused you to miss
the point there as well. He (and I) and every
podiatrist I know that is running a direct-pay
practice feels that they are a better doctor now
than they were before. And that is because a low
volume practice affords you the ability to spend
lots of time with each patient. The work-ups are
more thoughtfully planned and implemented. There is
lots of time to educate your patients and develop
deeper and more meaningful relationships. And every
patient gets all of you. And that leads to much
better patient compliance. Not to mention the fact
that there is enormous waste in paying employees
simply to have them chase after the money you are
owed by insurance companies. You may believe that
you are practicing to the best of your ability, but
I opine that simply because of the high volume
required to stay solvent in today's medical
"system", I can assure you that you are not
practicing to your best capabilities.

So let's grow up. Stop taking everything you hear
from myself or Dr. Roth as an attack against you or
other podiatrists that accept insurance. We post
about it because we know that our lives changed for
the better once we changed to a direct-pay model
and we want to share this with all of you because
we care about this profession. But sadly, this many
years later, this is still an extremely insecure
profession who quickly get their backs up against
the wall instead of being inquisitive and trying to
learn more. And that is your loss.

Robert Kornfeld, DPM, NY, NY

Other messages in this thread:

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05/08/2024    Robert Kornfeld, DPM

The Future of Podiatry (Rod Tomczak, DPM, MD, EdD)

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 avatar. What you all do not realize (and I
have experienced a very successful practice because
of it), is that in addition to your own practice,
every podiatry, orthopedic, rheumatology, PM&R,
neurology, dermatology, etc. practice has patients
they have failed in your city or town. So many of
your own you don't know about because they just
stop coming to you and you are too busy to inquire
as to why. There are also many patients who will
come to you because they don't have to wait for an
appointment and appreciate being seen at the exact
time of their appointment. Or they feel honored and
cared for because you have extended visits with
them to truly get to the bottom of what is going on
for them. There are many other reasons patients
will willingly pay you directly.

To make the uninformed, fear-laden statement that
no one would pay you is not only wrong, but totally
self-deprecating. The fees charged by doctors who
collect directly from their patients are not just
based on expenses. They are based on the time spent
and the value delivered. As I have said, I honestly
believe insurance will be the death of podiatry.
And because I travel in the direct-pay circles, the
movement amongst MDs and DOs who are leaving
insurance-dependency is gaining lots of momentum
and every one of them that I speak with is
celebrating their new found autonomy and freedom.
Does it take hard work to build this kind of
practice? Absolutely. But the hard work is
temporary. But if you continue to practice in a
system that exploits and abuses you and every day
you go to work is a hard day filled with stress,
then that type of hard work is permanent!

Unfortunately, too many of you only know managed
care or corporate employment. I went into practice
when the only insurance was indemnity coverage. We
were paid VERY WELL and I went to work every day
feeling proud and honored to be a podiatrist.
Managed care (in reality managed payments) has done
nothing positive for health care in this country
and has been responsible for ruining the lives of
countless doctors. In this day and age, a very busy
schedule is not the sign of a successful doctor. It
is the sign of a compliant doctor willing to work
for peanuts per patient.

It's all a choice. Adults can make choices that
serve them well in spite of their fear of change in
order to create a happier, healthier and more
satisfying life. Or not.

Robert Kornfeld, DPM, NY, NY

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05/07/2024    Greg Amarantos, DPM

The Future of Podiatry (Rod Tomczak, DPM, MD, EdD)

I find it interesting how a post can be
interpreted from a different lens and
diametrically opposing conclusions are reached. In
reading Dr. Tomczak's response to Dr. Roth, I read
Dr. Roth's post differently.

While we should believe we are providing the best
possible care, we have to face the facts, in
private practice, our treatment protocols are at
least partially driven by the insurance company
policies. I do not read any impugning of the
profession. Dr. Roth should believe he is
providing the best care, as should you and I.
Cash frees the practitioner from the shackles of
the insurance company policies. Think of the man
hours used on "meaningless use/MIPS" and the like.
Dr. Roth reminds me that medicine made a deal with
the devil years ago and I wish I had the
intestinal fortitude to have become a fee for
service provider.

Dr. Kornfield is correct, altruism does not pay
the bills. There is a disconnect in medicine
between an institutionally employed physician and
the private practitioner because the rules favor
the institution. Think "facility fees" which is an
upcharge of up to 30% in Chicago. In private
practice we do not receive a facility fee, thus
are behind the eight-ball by 30% when we walk in
the door. The employed physician is not worried
about staffing, expenses and the like, thus
altruism is a noble thought. The same cannot be
said of private practice.

Doing no harm and our call to do good do not have
to conflict. Not paying the bills does everyone
harm. Those in the ivory tower have to face the
facts. Forty years ago an osteotomy bunionectomy
was reimbursed at approximately $1,800. Today the
same procedure reimburses $800, not taking into
account inflation. Frankly, not a sustainable
model and thus, one is forced to change how they
practice medicine.

Why must our profession be jealous of others and
not be comfortable in our own skin? I applaud
Drs.Roth, Kornfield, Tomczak, Jacobs and other
members of our profession. We can all be
successful in different ways. After all, what
really defines success and better patient care?

Gregory T. Amarantos, DPM, Chicago, IL