01/04/2013    Robert Kornfeld, DPM

he Self-Esteem of Podiatry 2013

It is a new year, 2013. We have much to be
grateful for. But so much, in my humble opinion,
is going backwards that I think it is
appropriate for us to look at what is happening
and what we are willing to accept as
podiatrists. For starters, we have the Medicare
issue which seems to recur every year with
threats of large cutbacks. Then, at the last
minute, fees are "frozen" and everyone breathes
a big sigh of relief. Thank the Lord, no cuts
this year.

So the government sets you up, puts fear into
your hearts, then comes along at the last minute
to "save" you. Does anyone see the psychology in
this? They have figured out a way to get you to
celebrate that, for another year, you will be
severely underpaid for your services. Clearly,
not one of us has expenses that have remained
constant. So with frozen fees, you are receiving
a pay cut. Am I the only one who sees this?

Then we have our commercial carriers, whose
genius over the years was to completely take
over the practice of medicine, set the standard
of care and severely underpay doctors to
maximize their profits. So doctors have been
forced to condition themselves to think that
they will make it up in volume - for without the
participation agreement, no one will come to
seek treatment by them. But here, there have
been no fee freezes. The commercial carriers
have repetitively and consistently cut fees over
the years. And still, docs clamber to sign up
for participation.

So, in essence, you go to your office feeling de-
valued by Medicare and insurance companies. This
ultimately teaches the public to de-value your
services. This ultimately leads you to de-value
your own services. Unfortunately, human nature
is such that when you are not feeling
appreciated, you will find it extremely
difficult to be committed and you will not be
able to practice at the "top of your game". You
will lose interest, become a victim and sooner
or later will be an unhappy, unfulfilled person.

I lectured about a year and a half ago at the
Florida Podiatric Medical Assn. conference in
Boca Raton. With about 150 DPM's in the room, I
asked by a show of hands who loves being a
podiatrist and feels passionate about their
profession. Two people raised their hand. That
is 1.3% of the attendees. So it raises the
question, "How do you want to feel?" What are
your core desired feelings? I believe that the
reason the self-esteem of podiatry has
continually declined is due to the decline in
personal self-esteem. What have you been willing
to accept? What do you need to do to improve
your professional experience? How do you find
passion and fulfillment in practice? What is
your commitment to yourself?

The "head in the sand" approach has garnered
nothing positive. I think it's time we opened up
a conversation about this. It is time to EXPECT
MORE AND ACCEPT LESS. What is your
responsibility in your dissatisfaction with
podiatry? What is your next step? Where do you
want to see yourself at the end of 2013? Holding
your breath as Medicare cuts loom large again?
Complaining about the lack of respect you get as
a podiatrist? Hating insurance companies?
Convincing yourself that patients will not pay
for your services? Facing your own demons every
Sunday night because you're back in the office
on Monday?

Ladies and gentlemen, the pink elephant is
clearly in the room. Let's address it.

Robert Kornfeld, DPM, Manhasset, NY,
Holfoot153@aol.com

Other messages in this thread:

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01/12/2013    Tip Sullivan, DPM

The Self-Esteem of Podiatry 2013 (Jack Sasiene, DPM)

Hopefully, Dr. Sasiene realizes that not all
podiatrists accept insurance. I have practiced
for 23 years in a significantly podiatrically-
challenged area and have a mixed practice with
about 50% coming from surgeries. My attitude and
practice have not changed. It is very simple as
a podiatric physician the agreement we make to
care for someone’s feet is between us and them.
The responsibility to pay me in that
relationship does not reside with an insurance
company. It is the individual podiatrists choice
to accept insurance as an intermediary in that
relationship.

Will you see more patients by accepting
insurance? —of course! Will you make more money?
Years ago, I would say "of course", but in
today’s world, I would say maybe. The ding (28%)
that you mention to your practice has NOT been
caused by APMA. In fact, if APMA were not
supported financially by the rest of us, your
28% drop would most likely be much higher. Do I
and others get pissed off at APMA for the way
they handle things some times? SURE WE DO! One
of my rather simple-minded philosophies
regarding that is: Don’t complain if you do not
participate!

I guarantee you that things will not
miraculously change “by the will of Obama.”
Each one of us must DO SOMETHING to help change
things. What are you doing? How much of your
income and time are you using to further our
profession. Are you complaining about accepting
insurance and continuing to accept it? If you
are, then shame on you! If you are not, then
Keep it up!

Tip Sullivan, DPM, Jackson, MS,
tsdefeet@MSfootcenter.net

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01/11/2013    Gino Scartozzi, DPM

The Self-Esteem of Podiatry 2013 (Jack Sasiene, DPM)

I read the post by Dr. Sasiene and can
appreciate his frustration at what he perceives
within the APMA and/or his state society. I
would like to provide my two cents worth, so to
speak.

It was Former Secretary Donald Rumsfeld that
stated "You go to war with the army you have -
not the army you might want or wish to have at a
future date." This quote is especially prophetic
in what we all face with the turmoil of
healthcare reform in the future. Your state and
national organizations (APMA) represent your
interests on a much larger scale than that of
the individual in most cases.

I serve on many organizations within and outside
my profession. Are there instances when some
organizations can become "tone-deaf" to the
needs of it's membership? Are there instances
when "new" ideas are not received well by some
within organizations from the membership? It is
possible that can occur .... "been there, seen
that!" Alas, men are imperfect!

The organizations that thrive are those that are
open and inviting to new ideas and members. Any
organization that fails to implement this
philosophy, with time, devolves and degenerates
to the point it becomes extinct, through
abandonment, and heaped on the trashpile of
history.

However, I would ask Dr. Sasiene to reconsider
his membership withdrawl from the APMA and/or
his state component society. There are many
people involved in those organizations that do
help the average podiatrist in practice. Not
every "goal" sought by an organization
will "fit" every member's need every single
time. In fact, I would strongly suggest that he
not only become a member but participate
actively if his time permits. I would also
strongly suggest he contribute financially to
the political lobbying efforts of these
organizations. Why? Because in the end, Ben
Franklin stated it best ... "If we do not hang
together, we will certainly all hang separately."

One of the organizations that my family and I
that I proudly serve is the Boy Scouts of
America. One important lesson that is provided
through its ranks from member, to volunteers, to
leaders is that "leaders make change ... they do
not wait for it." This is a lesson all of us can
take from and any organization can use.

Gino Scartozzi, DPM, New Hyde Park, NY
Gsdpm@aol.com

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01/10/2013    Jack Sasiene, DPM

The Self-Esteem of Podiatry 2013 (Robert Kornfeld, DPM)

I appreciate the efforts of Dr. Kornfeld to
bring up the elephant in the room. It seems none
of our colleagues wish to discuss the REAL
issue, as none have responded. We are not in
control of our practices - medically nor from a
business standpoint. Anyone who thinks so is
fooling themselves.

Dr. Kornfeld asks, "What are we willing to do?"
Doctors, ALL doctors have an enormous amount of
power. That is why laws have been written to
restrict us. We gave up our power when we signed
up to work for insurance companies - all of
them. It does not have to be that way, it wasn't
before and patients got care from their doctors,
paid them and got reimbursed from the insurance
they paid for.

We have removed the patient from the equation in
an effort to get more money and have gotten less
and less. No fee schedule decrease is a loss;
just look at your bank account with little to no
interest and you are losing money to inflation -
It's thesame concept.

We must face the hard facts that continuing to
work within THEIR system is not good practice
management.

I have written the APMA repeatedly, without
response, about leading us in the wrong
direction. I am no longer a member. That is my
first step. I have to cut overhead somewhere and
they are doing nothing to keep my practice under
my control. What would you have done if your
income dropped 28% with you doing everything the
APMA told you to do? What would they have done?

Maybe this letter will generate some intelligent
response from the readers of this important
listserv, which in my opinion, is the only hope
for discussion in our profession.

Jack Sasiene, DPM, Texas City, TX,
Sasiene@aol.com