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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
Other messages in this thread:
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
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