05/13/2024    Robert Kornfeld, DPM

RE: The Future of Podiatry (IVAR Roth, DPM, MPH)

While I am in full agreement with Dr. Roth about
the joys of direct-pay, I completely disagree with
his assessment that only 5-10% of podiatrists are
cut out to be direct-pay practitioners. My
experience was that I had only one year where my
income dropped and that is because I dropped out of
everything all at once. It rebounded in year 2, but
that is NOT the way to create a successful direct-
pay practice. I do agree you need to provide
services that are unique so that you eliminate the
competition from insurance-dependent practices. But
any podiatrist who desires to can create a
successful direct-pay practice by first getting
expertise in a niche. Then, drop your lowest payors
and start seeing your niche patients for direct-
pay.

As you build your brand and are consistent with
marketing, they will come. And you will be
surprised at the number of phone calls you will get
asking what you do differently. I speak directly to
all new patients so that they know I am accessible
and I know they were given the right information.
And when I speak to patients directly, my
conversion rate is over 90% of callers become
patients.

I implore podiatrists to stop shaking in their
boots. The longer you allow the exploitation and
abuse from insurance companies or corporate
employers, the longer you will be miserable. Don't
ask your accountant. He will base his opinion on
your current financial status. And if he tells you
can't afford to do it, then that is all the more
reason that you should since you have no financial
security in the current insurance-dependency model
you are practicing.

Clearly, the current model is killing the income of
well-trained and bright podiatrists who have
willingly become victims of the system. The fact
that Dr. Udell had the audacity to question the
ethics of direct-pay doctors is an admission of his
fear and jealousy. It is the most absurd statement
I have ever heard about this practice model. And
Dr. Rubin states that you should outsource your
billing to RCM companies who will also be siphoning
off of your income. And that does not change the
low fees and administrative burdens that come with
a high volume insurance practice.

I have been in podiatry for a very long time. I
started NYCPM in 1976. Back then, I was astonished
at the low self-esteem of this profession, but I
was confident it would improve as we became better
at what we did both surgically and medically. Yet,
all these years later, in spite of our education
and training, a lot of you out there cannot even
say that you are podiatrists. You tell people you
are foot and ankle surgeons or wound care
specialists or sports medicine doctors, but somehow
the word podiatrist is left off of your sound bite.
That is the ultimate in shame and insecurity.

Practicing a direct-pay model has not only elevated
my self-esteem and joy of being a podiatrist, but
it has afforded me a lifestyle that leaves me
feeling relaxed, confident and able to do whatever
I want. And that is what you all deserve. Not the
bullshit you deal with every day.

Robert Kornfeld, DPM, NY, NY

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