Navigating The Tough Economic Times: Can It Make You A Better Doctor?

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John H. McCord, DPM

Podiatrists are experiencing a trifecta of challenges. The world economy has taken an extended potty break. Healthcare reform has created uncertainty for the entire medical sector. The Centers for Medicare and Medicaid Services (CMS) does not know if we are actually physicians. We are living in interesting times.

   These types of challenges were normal in the community where I practiced for 34 years. Our county experienced double digit unemployment rates during many of my practice years. I chose to view it as 85 percent employment rather than 15 percent unemployment.

   Doctors and hospitals had to tweak business policies frequently to meet patients’ needs during difficult economic times. We usually succeeded. The few greedy types did not last long.

   The medical community was slow to accept me as a real doctor. This never bothered me as long as my patients were happy. By the end of my career, I had served as president of the county medical society, chairman of the hospital board and chief of surgery. I have a part-time post-retirement job as a physician consultant for special hospital projects. I also serve on a board that oversees physicians hired by the hospital.

   The challenges that all of medicine and especially podiatrists are facing have been par for the course for my community. Our not-for-profit hospital has operated in the black during the past four years and none of our physicians is starving. The four podiatrists in our community are all doing very well. Patients in our community always have access to quality medical care despite their economic circumstance. We practiced healthcare reform before it became a political football.

   Medicaid has dropped podiatry in several states including mine as of January 1, 2011. Our state association is working hard to reverse this decision but it may go through. This will be a big challenge to podiatrists who have continued to care for the poor.

   I lived through the loss of Medicaid in the early 1980s but survived without ever denying care to a patient for economic reasons. We set our patient fees at the cost of a carton of cigarettes. Uninsured patients who claimed to have no ability to pay had a lot of explaining to do if they had a pack of cigarettes in their pocket or smelled of tobacco smoke. Cigarettes have gone up in cost faster than healthcare so I am not sure if it would be a fair deal during this recession.

   My staff became good at determining ability to pay and during the time we were denied Medicaid funds, my practice did well. I also sent Polaroid pictures of foot ulcers to the governor when the patient had no funds but still needed care. The governor’s staff asked me to quit sending the pictures because they were sickening. I agreed to if he would reinstate podiatry for Medicaid service. Sending photos would have been a HIPAA violation but we did not have that law in the early 1980s.

   Another thing that kept us going during the difficult years was that I saved and invested during the good times. There were times when I used personal assets to keep the practice going. When things improved, I paid myself back. In the end, I retired comfortably and never had to look back with a guilty conscience for denying care to a patient in need because of his or her lack of resources.

   The young man who took over my practice has the same care philosophy and has found podiatry to be a rewarding profession. Like me, he worries about his patients more than his income.

   We are likely to have a few more challenging years and may have to adjust to some new normals before healthcare reform settles down. I believe podiatry will come out well in the long run. Our residency graduates are well prepared to continue being the top quality choice for medical and surgical care of the foot and ankle. The aging Baby Boomers are going to demand quality foot and ankle care in ever increasing numbers.

   The medical community and the feds will likely continue to quibble about whether podiatrists are really physicians. While they are having that battle, I think we should concern ourselves with good foot and ankle care for our patients. People occasionally ask me if the attitude of the medical community toward podiatrists ever bothered me. I answer, “Yes and I cried all the way to the bank.”

   Looking back on my career, I know the difficult times always made me a better doctor. I am sorry to be missing out on this in retirement. I admire the practicing podiatrists who are continuing to do a wonderful job.

   Dr. McCord retired from practice at the Centralia Medical Center in Centralia, Wash., in December 2008.

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