by Jarrod Shapiro, DPM Joined practice July 2006 of John K Throckmorton, DPM Lansing, Michigan

As many of you know, I currently practice podiatric medicine in Lansing, Michigan, and you may be aware that Michigan is one of the states hardest hit by the country's economic woes. As a result of this, I'm seeing increasing numbers of indigent and Medicaid patients. Now, as I've mentioned previously, to make matters worse, my boss does not see Medicaid patients. As a new physician I make it my policy to accept ALL hospital consultations without regard to insurance status. Consequentially, I'm seeing greater numbers of patients for which I receive NO reimbursement. I know what you're thinking: "Shapiro's crazy. He's working for free." Yes, you're right. I am crazy. However, as an associate to another physician I am bound by his rules and cannot participate. Let's avoid this part for the rest of the discussion. Feel free to write in about this if you'd like!

So, I mentioned I have an idea. Certain physician positions around the country offer paying financial aid loans as an incentive to work. An example of this is the Indian Health Service. For each year of service they pay a certain dollar amount of the doctor's federal loans. My idea is to expand this into a national program where the federal government offers forgiveness or repayment assistance to physicians who agree to see indigent patients.

For example, for every X number of indigent or Medicaid patients I see in a one year period I would have X dollars subtracted from my financial aid principle (or alternatively, the government would make a payment to my loan carrier of a certain dollar amount towards the principle). I mention principle specifically because applying payment to the principle has a much greater impact on loans than a regular payment or payment to interest.

For a new physician like me with a house-sized amount of financial aid obligation, this would be a strong incentive to see patients who are underrepresented. In my state it's very difficult to find a physician who will see uninsured or Medicaid patients. With my reimbursement plan the doctors and the patients would benefit. It's a win-win situation. What do you think? Should this be the next great APMAPAC drive? I'm all for it!!

LETTER TO THE EDITOR

***Choice vs. Unity***

Thanks for the excellent job you do concerning the new Docs editorials. I try to read them whenever I can. I did want to point out what seemed to be a mischaracterization of the upcoming ACFAS vote concerning unity with APMA.

You mention that "apparently, ACFAS members are not happy with this arrangement." I don't think that properly describes the situation. I'd say that some ACFAS members are not happy with the requirement to be a member of APMA in order to be a member of ACFAS. However, the vast majority of those whom I have spoken to are in agreement that dual membership (and following the APMA Bylaws requiring dual membership for affiliated organizations) is of the up most importance. In actuality, the ACFAS Board of Directors decided that dual membership with APMA after the first year of membership in ACFAS wouldn't be required.

Members of ACFAS filed a petition requiring that dual membership be required at all times. Hence, the ACFAS Board of Directors is now doing the membership vote which requires a 2/3 majority to make an ACFAS bylaws change. We'll have to wait for the results to see what the average ACFAS member really thinks.

Also, the description of what is being voted on didn't seem to be portrayed as accurately as the actual wording of the vote from the ACFAS web site which states:

"The ACFAS Board of Directors recently changed its membership requirements to only require membership in APMA upon initial admission into ACFAS rather than require it all times. By voting to SUPPORT the Board, you accept the ability to choose your professional memberships as permitted in the current bylaws. By voting to REJECT the Board's decision, you would be voting to change the bylaws to require APMA membership at all times during your ACFAS membership."

Thank you for making the judgment that being a member of both organizations is what is best for podiatry. I hope that we receive a 2/3 majority of our ACFAS membership to REJECT the ACFAS Board's decision and require dual membership in APMA and ACFAS. This will also allow ACFAS to maintain its affiliate status with our parent organization, the APMA.

Best wishes,
Bruce G Blank, DPM, FACFAS
Martins Ferry, OH

***Solo Practitioner Responsibilities***

I am starting out on my own in a few months. I have been working as an associate for another doctor since our graduation. Currently, I take all call as an associate, and when I am out of town, my boss takes the pager. As a solo practitioner, I am wondering what the protocol is for coverage when I am to be out of the office.

Aside from being on call at a hospital, what obligations do I have to my office patients after hours? Can I just give them a phone number or pager number on my answering machine for when I am within a phone's reach for phone consult? What about when I have to go out of the country? Am I obligated to have another podiatrist cover for me?

-Giao Nguyen, DPM

Editor's Response

Great questions on what might at first seem like a small point but in reality is very important to your overall success and happiness as a sole practitioner.  This is a situation where your relationship with other podiatrists in the area can be very helpful.  From my experience most podiatrists in sole practice will have a local podiatrist cover their office and hospital call when they’re out of town.  If you use this method, be sure it’s a doc you know well and can trust.

As far as your general obligations to your patients when you are in town, I guess that’s up to you.  However, I’d argue that your patients want someone who’s available to them at all times, not just nine to five.  Part of top quality care is being available.  If your patients consistently have trouble communicating with you they’ll find someone else.  Currently, I leave my pager number on the office answering machine, but ask that patients only call it in emergency situations or go to the nearest ER.  I’d consider leaving the country the same as vacation, and yes, if you want your practice to grow and your patients to feel confident in you, you will have some kind of coverage system set up.  Remember, medicine is at its most basic level a service industry.  So, just like McDonald’s you have to provide superior service to your patients.  Part of that service is being available to them!  

At the conclusion of this week's issue we offer a press release regarrding AAPPM Practice Management Mini- Seminar for Podiatric Residents. Please read on.

Good luck with your new practice.

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]