I’m now retired. Looking back, I think the
enrollment crisis goes beyond simply looking at
the economics. I attribute a large portion of it
to the over-the-top and worsening hassle factor
associated with practice.
When I entered podiatry, I was motivated by the
satisfaction of helping people, the intellectual
challenge of making diagnoses and solving
problems, being able to administer treatment and
see positive responses, forming long-lasting
relationships with my patients and those with whom
I worked. I enjoyed a successful private practice,
did my share of surgery, established a very good
reputation in my medical community, was chief of
the podiatry service at a major hospital, never
really set the world on fire but made a living
that I was happy with.
Then one day it happened. The door to my reception
room would make a distinctive “click” when
somebody comes in, and was faintly audible
throughout the office. On that afternoon, I had a
few moments to catch up with some administrative
work. Perhaps it was charting, dictating op
reports, writing checks, returning calls, checking
labs, completing some sort of application…
whatever. I heard the distinctive “click” and
immediately felt my stress level skyrocket then my
immediate thinking was literally “Son-of a bitch!
I’ve got to see a patient!” That was the defining
moment telling me things had changed.
It hit me that there were almost a dozen entities
or government agencies to which I was accountable.
Count ‘em - - there’s HIPPA, OSHA, IRS, State Bd
of Examiners, Dept of Health Radiation Control,
Hospital Staff Offices, Department of HHS
(Medicare and Medicaid), Workman’s Comp
Commission, State Employment Commission, Managed
Care/PPO contracts, my professional liability
insurance carrier, etc. Each has their own unique
rules, requirements for detailed and updated
record-keeping, some requiring logs to document
periodic office meetings and staff training, on-
the-spot inspections, etc. And each carries the
threat of huge consequences associated with not
being in compliance.
I could lose my license, I could be fined, I could
be forced to refund over-payments that weren’t my
fault, I could go to jail, I could lose my
hospital privileges, I could be dropped from
managed care panels, I could get sued, I could
have my X-ray machine shut down, I could be
required to notify all my patients of a data
breach that was not my fault and at my expense,
etc, etc. Whether I wanted it to or not, patient
care had suddenly taken a back seat to compliance
with those entities.
That kind of pressure becomes a distraction from
the time and effort that would otherwise be spent
on patient care. Unfortunately, the result can
give rise to making mistakes, cutting corners at
the expense of quality care, allowing things to
slip through the cracks and incentivizes cheating,
inappropriately coping/pasting of records, etc.
I don’t care who you are, who your office manager
is, what kind of software you use, whether you’re
in a private, concierge, or group practice - -
NOBODY can totally comply with all of that. Each
of us is ultimately accountable and we’re all
vulnerable. That was a large part of my burn-out
and decision to leave practice.
Carl Solomon, DPM, (Retired), Dallas, TX
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