03/31/2026    Robert Kornfeld, DPM

RE: Why did you decide to pursue a career as a healthcare provider? (Elliot Udell, DPM)

When I hear any doctor state that they became a
doctor solely to help people, I have to question
that reality. I think we all went into medicine to
help patients. But would any of you have put in
all the years of education and training (and DEBT)
to pursue a career that did not have the capacity
to provide a really good income?

Let's be honest. Is the reason that podiatry
enrollment has dwindled over the years because of
a loss of interest in the human foot? I think not.
What I believe (and all you have to do is go to a
podiatry conference to hear it) is that the
majority of podiatrists are fed up with insurance
and Medicare burdens and hassles and they DO NOT
encourage young people to follow this path. They
are miserable and angry. Couple that with the fact
that you can become an NP and practice on the
entire body in an independent practice.

Like I said in my prior post on the subject, I
believe we have TWO reasons why podiatry is dying
a slow and painful death. The first is dwindling
insurance reimbursements. The second is the lack
of a plenary license.

But there's more than meets the eye.

I've been invited to speak to a group of
orthopedic surgeons. They have a plenary license.
Yet, this group of surgeons is also fed up, tired
and disgusted with what is happening in the
insurance-dependency model. And they want to learn
about the merits and benefits of a direct-pay
model and how to create a successful independent
practice. Why am I sharing this? Because for them,
as well as us, making a superior living is an
essential part of what drives all of us to work as
hard for our patients as we do. Altruism does not
pay the bills.

The move to direct-pay models is burgeoning all
across the country. Those who have convinced
themselves that "their patients will never pay
them" have no understanding of how this model
works. I am friendly with many MDs and DOs who
have walked away from insurance and gone to a
direct-pay model. And I do know quite a few DPMs
who have made the same move. I haven't heard
anyone say they are sorry. In fact, they all
celebrate their courage to do so.

It's not about loading more non-covered services
into your office. It's about a system that is
destroying medicine and has conditioned patients
not to value anything you offer that might cost
them money. Direct-pay physicians de-condition
patients to pivot and gravitate to value-based,
not volume-based offices.

There's so much to talk about. At 71, I'm still in
love with practicing and I am still trying my best
to help this profession see things from the bird's
eye view that I have after all these years.

Robert Kornfeld, DPM, New York, NY

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