LETTERS TO THE EDITOR

***Responses to I Have An Idea***

Dr. Shapiro - it's nice to see someone who is enthusiastic. Do you think you are the only one who sees indigent patients? or patient's for free? LOL... sorry, about the laughter. "Your idea is fantastic", I have been preaching the idea for the last 10 years. Loan forgiveness huh? This is like Men are from Mars and Woman from venus. Since you are from Michigan let me clue you in to how things work in New York. Podiatrists don't get paid to see Medicaid patients. that is thanks to a handful of docs who commited fraud by dispensing non custom orthotics as custom. So Medicaid decide to punish us all. This happened I am told about 15 years ago. harsh punishment no?

If a patient is Medicare as a primary and Medicaid as a secondary we used to get the 20% from Medicaid up unitl about 3 years ago. Then the city budget which was strapped decided to pay us 20% of the 20%. So on a 100 dollar visit where we used to get 20 bucks we now get 4. What do you think about that? I have called, written and inquired about the fairness of that to my state associations to which I am told.." this is not a podiatry specific problem, this happened to all doctors...My natural reaction was so what are we gonna do about it? I had the same zestyness that you display as a neophyte in a nebulus world. My screams have fallen on deaf ears...but i do think "your idea" is brilliant. (By the way, I am not taking credit for the idea, I sure we aren't the only Einsteins that came up with it.)

With regards to seeing patients for free - In order to have staff privledges on the hospitals I am affiliated with - it was mandatory for me to do clinic sessions without pay, mind you podiatry was the only specialty where clinicians weren't paid. If we didn't like it - we didn't have to be on staff.

Two years ago, a new chief of Podiatry came on. He changed things. He took all the Podiatrists off the clinic schedule, placed himself and his associates on the roster, then got the hospital to pay them. Ahhh, you think life isn't fair in Michigan?

Jeffrey Kass
Forest Hills, New York
[email protected]

Why would the government pay anything to you, me, and a lot more like us who are currently seeing patients like this for free or little to no reimbursement? I also have a policy of seeing whatever I’m consulted for, but there has to be a limit. When it’s all free care, and the consult comes from the hospital-employed docs in the ER, my kids see me less, and I can't feed them with that donated time. I still go, but now I consider it community service and have started to limit that.

Good luck, and remember you can't ever get that time with your kids back. There are always places to give your energy to. Try and find a balance. If you allow it, there will be nothing left.

One doc told me he calls me because he knows I’ll come, whereas the hospital-owned ortho group won't because most free care generates no RVUs for them.... At the same time the insured patients were being filtered at a higher rate to them then to me. When I inquired why 3 of my patients seen at the ER with met fxs were sent to the ortho group for ORIF they replied they didn't know I did that sort of work. One pt showed up on my doorstep with x-rays in hand stating she was told the only people that fix broken bones are orthopedics, even after she asked for me. One year previously I had fixed a Jones fx on her, and she knew better.

The docs asking for your help know that you'll work for free. That’s why they call. I used to keep my head down and do the best work in the ER I could for free hoping that would help the referral stream. Now I value my work, my time, and the energy and I have put in. My boundaries are now firmer, and when I do go (which is still a lot) I go as a gift with limits. This you need to think about.

Yours Fraterally,

Andrew Smith, DPM
[email protected]

Sounds like a great idea...

MICHAEL LEE
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Amit Luhadiya, DPM
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Jarrod I too am a new practitioner and have/had a similar situation with one of the hospitals I participate with. I see a huge amount of Charity Care patients and at times don't get re-imbursed for any of the patients I see. However, the medical attending see this and have sent referrals from their private practices with "better paying commercial insurances".

I think it’s the nature of the beast to take insurances that don’t pay well especially for the new practioner(s) who've only been out for 1-5 yrs. You have my support for the financial aid support program you want to initiate in seeing the indigent population. Amit Luhadiya, DPM

Lyndon Lamb
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It would great if part of my student loan principle were reduced each time I saw a patient with Medicaid or no insurance. I've been working at a clinic part time for the last five years and I love it. Everyone deserves good and consistent medical care, and I enjoy supplying such service to them. Also, they are generally very grateful patients, and appreciate seeing a professional who doesn't judge them based on type or lack of insurance. I'm fortunate to get a little compensation for their visit, though if I saw a patient with regular insurance in an office I would be making a bundle more. It's very tough with my large student loan as I just barely cover the interest on them with the clinic reimbursement. Regardless of the struggle, it's worth it. The feeling of fulfillment I get from such service is priceless. Still, it would be wonderful if I could have a chunk of my principle eradicated based on my work there.

Kudos to you for seeing patients as people first!

[email protected]

***Board Certification***

I have read with interest yours and others messages in regards to board certification. I am currently president of ABPOPPM and am dual boarded. I also am the director of a PM&S-36 residency program in a teaching hospital in Binghamton, NY and Johnson City, NY. The hospital also maintains residency programs in internal medicine, family practice and transitional medicine and fellowships in sports medicine and geriatric medicine.

As you probably are aware, APMA has embarked on VISION 2015 in order to ensure that our graduate medical school training and post graduate residency training will enable successful graduates of same to be comparable to MD's, DO's and be defined as a physician. Allopathic and Osteopathic medicine will be examining and is cognizant of the education and training of podiatric medical students and residents in MEDICINE. I am referring to experiences comparable to medicine experiences for allopathic and osteopathic physicians. Experiences in and not restricted to: Primary Medicine, Rheumatology, Infectious Disease, Renal Disorders, Pediatrics, Medical Imaging, Pathology, Dermatology, Cardiology, etc. These areas are tested and examined only by ABPOPPM.

CPME has directed that a "re-write" for CPME 320 be initiated beginning in the Fall of 2008, this year. The re-write will focus on medicine and medicine sub-categories in order to attempt for fulfill the goal and vision of VISION 2015/

I encourage and actually urge all graduates of comprehensive residency programs to become dual certified for a number of reasons: 1. Most of your patients will present with medical conditions which may be contributing to their lower extremity complaints. 2. JCAHO has issued a directive which encourages all hospitals to allow Podiatrists to perform admission H&P's on ASA Class I and Class II patients. 3. Podiatrists within Medicaid will be defined as Physicians as we are now under Medicare. VISION 2015 will allow Podiatrists to be defined as Physicians with the concurrence of AMA and AOA. Therefore, Podiatrists with the requisite education and training will be defined as Physicians nationally and within the states. Podiatrists defined as Physicians will admit patients to hospitals, perform H&P's on certain classifications of patients and serve as "Captain of the Ship" with hospital admissions.

As we have seen within certain states, Podiatrists with the requisite training are able to include foot and reconstructive rearfoot and ankle surgery in their scope of practice. VISION will also enable Podiatrists with the requisite education and training to be defined as a Physician. Definition as a Physician I would deduce would include responsibilities and privileges beyond those of most podiatrists today. Secure as much training and certification as you are able. It will benefit you tremendously in your practice life.

Joseph T. Hogan, DPM
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***Surgical Timing***

Hi.....a friend Dr John Bremyer Sr[DPM] of Tiffin Ohio[passed a few yrs ago] said wait 6 months before you operate and try non-surgical Tx and get to know the patient......as I look back on 40 yrs of practice I concur.

Stan Southward DPM  
Colorado Springs
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