The Direct Care Way

Dr. Bob Kornfeld on Functional Podiatric Medicine & True Freedom

October 31, 2023 Season 2 Episode 90
Dr. Bob Kornfeld on Functional Podiatric Medicine & True Freedom
The Direct Care Way
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The Direct Care Way
Dr. Bob Kornfeld on Functional Podiatric Medicine & True Freedom
Oct 31, 2023 Season 2 Episode 90

What's spookier than working for insurance and never knowing when you'll get paid?
Dr. Bob Kornfeld talks about his unique specialty as a functional podiatric medical expert helping people with chronic pain and how he's crafted a private practice free of insurance for over 20 years. 

He offers a course for podiatrists interested in functional medicine. Email your interest here

Show Notes Transcript

What's spookier than working for insurance and never knowing when you'll get paid?
Dr. Bob Kornfeld talks about his unique specialty as a functional podiatric medical expert helping people with chronic pain and how he's crafted a private practice free of insurance for over 20 years. 

He offers a course for podiatrists interested in functional medicine. Email your interest here

Dr. Tea  0:00 
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise. The doctor gets full autonomy in how they care for patients and how they get paid. They have chosen this path with a love of medicine. This is the direct care way.

Dr. Tea  0:24 
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic, and the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.

Dr. Tea  0:52 
I've got a super special episode because I'm going to bring to you another guest, a direct care veteran who is a podiatrist, practicing functional medicine in New York, who has no plans of retiring from medicine. He is 100% Fully cash has been in practice as a cash practice for over 20 years, but has been practicing medicine longer than that in the insurance base model. So we talk about our common enemy insurance and why the long term life of an insurance model practice is really not sustainable. And this is going to be relevant to not just podiatry, but to all specialties. So if you're not a podiatrist, I hope you stick around to listen to this conversation and take away a couple of gems as we spill the tea on Dr. Robert Kornfeld, transition out of insurance and into his direct pay practice. And he's still going so let's just jump right in.

Dr. Tea  1:47 
Thanks so much for joining me today I have a special guest. This is Dr. Robert Kornfeld. He's a 1980 graduate of the New York California pediatric medicine school who opened his own practice in 1982. In 1987, he began incorporating a holistic medical model into his practice of Podiatric Medicine, and was astounded by the results that he was getting with his patients. That led to a complete break from insurance dependency in 2000. And he has been a direct care doctor ever since. So welcome, Dr. Kornfield.

Dr. Kornfeld  2:23 
Thank you, T. Pleasure to be here.

Dr. Tea  2:26 
So when we first started to chat, you actually call it direct pay. And I think it makes total sense. Because the transaction is direct.

Dr. Kornfeld  2:37 
I'll explain why. We're all in direct care whether we're accepting insurance or not. Right, we're sitting in front of a patient, were interviewing the patient, we're diagnosing the patient, we're treating the patient. That to me is direct care. But when you cut the insurance company out of the mix, and you're doing the type of medicine that you feel you were trained to practice that you feel is the best for your patient. And the patient is now paying you directly for that privilege. I will call it direct pay

Dr. Tea  3:13 
Semantics. And you know, the reason why I chose direct care as the title of my podcast really is to demonstrate a movement towards physicians just taking control of their practice. So whether you say direct pay or direct care, we don't always have direct care if we're dealing with insurance. And I think you know what I mean, when I say this, when we go about getting a imaging like MRI, because we want to do surgical planning, the insurance has complete control in whether or not the patient can get that in the way of reimbursing or paying for that imaging, right. So they have an indirect influence in how we practice medicine, and they can delay patient care. So direct care in my eyes is not always direct. If you're dealing with insurance, even if we're face to face, it always feels like when you're working with insurance, there's somebody else in the room kind of watching over you monitoring where the money goes. And once it's even paid to you, they have all the right to call it back through audit. And that's kind of why I moved into that direction of calling in direct care. But I totally understand what you're saying with direct pay

Dr. Kornfeld  4:16 
We look to different things. But precisely that reason that insurance interferes in the integrity of what we want to do for our patients, and limits access to certain diagnostics and certain treatments. That to me, makes a really big problem. And one of the reasons that I initially walked away from the insurance debacle was I saw what was going I saw the trajectory. I mean I was there long before managed care. We had nothing but indemnity insurance. There was no such thing as CPT codes, ICD codes, prior approvals, none of that existed. We did what we did, we got 80% The patient paid 20% And that's how when until managed care came. And that's when everything started going south, as far as I'm concerned, because they started with decent fee schedules and all of a sudden fees, were getting cut fees, were getting cut fees were getting cut, then all of a sudden it was we're not approving this, it's not medically necessary. not medically necessary. What do you mean, I'm the doctor here, I deemed medically necessary, I don't care what you think. But I had signed the contract. And I was stuck. And they were making decisions for me. And I knew it wasn't based on medical care, it was based on the bottom line financial algorithm that they were running their business by. And when you really think about it, health insurance companies are not in the health care business at all. They use health care as a vehicle to collect premium dollars. And then they want to keep as much of it as they can. And they've created an amazingly successful system where doctors and patients are being exploited and abused. And, you know, when I walked away from it, nobody else did. And everybody told me, I was an idiot, and I was gonna go bankrupt, and I was gonna lose my practice. And all of the things that, they were telling me didn't stop me because I thought to myself, if I can't do this, the way I want to do it, I don't want to do this at all.

Dr. Kornfeld  6:24 
And I was pretty surprised that in the first year, it looked like I was gonna go back. Because I didn't know how to get the word out. I was novice with this. But it only took about a year and a half. And people started coming in and people started coming back. And I learned to do public speaking and I developed the presence and I learned how to communicate what I was doing. And little by little, it became something valuable to my patients. And what I was really excited about, and I still am, is that I don't work hard at all. But I put my all into every patient that comes in the door. So they're getting Bentley medicine, whereas when I was accepting insurance, you know, it was Ford medicine, if you know what I mean, I can, I can do so much more I can be so much more complete and thorough and comprehensive and connected. And I'm sure you're all, you know, bear me out on this, that the potency of your doctor, patient relationships has gone incredibly better than it used to be when you were in a rush and had to run from room to room. You know, and I used to get yelled at by my staff all the time, because I happen to be a bit of a Yenta. And I like to talk in conversations with patients and get really backed up. But, you know, once I got out of that, you know, insurance thing where I was myself seeing 60, sometimes 70 patients a day. It was insane. It was insane. And that was way back then. And I hated it. I can't imagine what it is now, because you're probably getting 25% of what I was getting paid in insurance dependent practice. So

Dr. Tea  8:14 
Yeah, there's definitely a difference in academic medical care. So what somebody said to me was, if they want to use their insurance, they can go to a place that has the resources for it, like academic centers or institutions, because they essentially have a bottomless pocket they can spend and they can write stuff off. But when it comes to private practice, we don't have to function as an emergency room center where we see everybody for whatever dollar or negative dollars. In fact, that's the worst way to run your private practice. But I really want to pull you back a little bit and ask you what was your turning point to walk away from insurance? I mean, you walked away in 2000. So that's been a long time. And I'm sure the dynamics of medicine have changed significantly since then.

Dr. Kornfeld  9:00 
Well, back then, I believe it was sometime around 1999. I received the request for records from Blue Cross Blue Shield. They wanted 40-45 charts. And I sent them and I got back to notice that they wanted me to reimburse them $87,000. I said $87,000 Why am I returned? Well, we don't cover what you do. I said well, you read my records, but you didn't look at what I billed for. That wasn't billing you for any of the holistic medicine that was privately contracted between me and my patients. The only thing I billed you for were covered services. Initial exams, subsequent exams, well, but your exams were about holistic medicine. So we want the money back. I said well, you understand I'm running a chronic pain practice. And these people come to me after having seen 5 - 6 - 10 doctors, did you want me to do the same exact thing that already failed? I'm doing things differently? Well, you're gonna have to refund the money. So I'll tell you what, I'm not gonna give you back a nickel. We'll, we'll duke this out. And then I called him back. This was the investigator that had to speak to. And I said, I'm just going to do you and me a favor, and we're going to settle this on television, I'm going to CHANNEL SEVEN NEWS. And I'm going to ask them if they want to put this on the news. Because this is something that I think the public should know about. And then I got a letter asking me to settle for $25,000.

Dr. Kornfeld  10:40 
So I contacted all the patients whose charts were looked at. And I asked them, if I went to court, would they come and testify on my behalf. 39 Out of the 45 said they would come. So I told Blue Shield, they'll see you in court and 39 witnesses that are going to tell you that what I did work for them. Then they told me, Well, we were going to let this go but don't do it anymore. So I say you know what? I'm done with this. Because I know what happens. Once Blue Shield does that they tell Aetna, they tell Cigna, they tell Medicare, everybody starts investigating you. And I wasn't doing anything wrong, I was just doing things very differently. So at that point, I thought, the direct pay side of my practice, was earning money with a lot less volume. But I was getting much better results. And I said, let me see how this works. If it doesn't work, I'll just go back to playing my music and be a musician again. But that was really the straw that broke the camel's back.

Dr. Tea  11:45 
That's a lot of money. I've heard doctors say, when they undergo an audit, they um, they're having to take out a second mortgage to pay back to make Medicare or something because you can't not pay them. They're the government. And that makes us so

Dr. Kornfeld  12:01 
Yeah, the whole thing with Medicare especially because, because I've, I've had I have a friend, that's a cardiologist and he went through an audit. And he just refused to give the money back absolutely refused. When he went on his social security, when he reached his full retirement age, they withheld all the money that he was supposed to pay. So they get you one way or the other. But, you know, the whole thing is if you're not in the system, and you're not subjected to their whims and guidelines, because they only do it to maximize their income, then you can practice medicine, the way you see fit, the way you were trained, and the way that you express it as an art. Because, you know, in my opinion, there's about 10% of science in every office and 90% art, we all do things differently. You know, and that's the beauty of practicing medicine. And why I prefer free market medicine is competition would manage the cost, like it did before managed care, where you have lots of doctors in a particular area doing similar things and different things. But you know, nobody's going to charge outrageous fees that put people into bankruptcy, like, what happens now, you know, when an insurance company says, Oh, by the way, we're not going to cover the $1 million hospital stay because the doctor didn't dot the I's and cross the T's. That doesn't happen and direct pay direct care, I don't even know what to call it. But you know, such a different way to practice. And it's so much less stressful. And doctors today are just suffering, they're all suffering. You know, they have so much stress, it filters into their home life because they have to do charts at home. You know, they're stressed out beyond anything, then they see a million patients a month, and then they can't even pay their bills. Because the reimbursements are so low, or a lot of the claims are denied or the insurance company says, Oh, we never got that claim. We don't know where that claim is, you know, they have a million excuses to float the money. But I find when a patient pays me directly, there's a huge increase in compliance. And a trust factor that changes because they don't see my office as a factory, you know, patients in and and blah, blah, blah, everybody's crawling all over each other in the waiting room and a lot of these offices. It's very intimate and very different. And I'm in love with the way I practice. That's why at my stage of life, I'm still going work. I'm still practicing, not practicing full time anymore. But I I don't know if I could ever get this. It's just such a great satisfying way to practice.

Dr. Tea  14:58 
You had said something that I thought was really worth digging into. And it was about how when people think about direct care, direct pay, or even concierge medicine, there's a criticism even on LinkedIn. And you can see in my posts and post op similar nature where we talk about not working with insurance, there sure is always that one person who says, Well, not everybody has the luxury, or the finances or their circumstances to afford out of pocket. So they're criticizing cash pay practices, saying, well, we only serve the rich people, wealthy people. But you said the exact opposite. You said, when you work with insurance, the insurances are getting billed these astronomical fees through the the hospital systems, the various doctors that have to be consulted, they are the ones that are pushing the patients to bankruptcy, premiums are high deductibles are high. And nobody knows the cost of anything. So really, you can put whatever your rates are, no one is going to regulate that. So I think that's a big misconception about direct care is that we are out to bankrupt people. But in fact, insurances are doing that. It's not us. We're serving others.

Dr. Kornfeld  16:11 
I'm glad you picked up on that. Because I think it's an important point that if you add up all of the money that people pay in premiums, and then add deductibles, and then they add co pays, and then throw in all the non covered services in the surprise bills, they would do a lot better paying their doctors directly and purchasing a catastrophic plan. If God forbid something bad happened, there's no comparison. No comparison.

Dr. Tea  16:39 

Dr. Kornfeld  16:40 
But because a lot of doctors are compensated to the system. They think, Oh, sure. You're, you know, you're charging a million dollars a visit. And it's only the rich people that come. And it's totally not true. There are some people that come to see me that I actually want to give them the shirt off my back. They look like they're struggling. But they saved for months and months and months, because they knew what they wanted to do. And they come in, and they pay. And they're incredibly grateful people. It's not just the wealthy coming in, not even close to that. I'm sure you'll hear me out on that.

Dr. Tea  17:18 
Oh, yeah, I mean, I've had people who are well, in the millionaire billionaire status come in, and they don't want to pay a whole lot. And then they have people who are farmworkers for who are grateful, they're like, I'm gonna find the money, I'm gonna babysit my grandchildren. This is important to me, I'm going to make it work. So I get the entire spectrum of people, you can't judge people on what they're wearing, what they're driving, and how they want to spend their money. And I wanted to ask you what, what other misconceptions Do you see about your direct pay practice,

Dr. Kornfeld  17:50 
By the public or by other doctors?

Dr. Tea  17:52 
Both because I think it's really important to distinguish because it's really doctors attacking other doctors, that's going to be the most hurtful, because we speak the same language versus consumer to doctors, we understand there's going to be a little bit of a push, let's start with doctors, talking about doctors.

Dr. Kornfeld  18:09 
One of the issues I have dealt with, which I rarely deal with anymore. But when I went direct pay, and I'm also a functional medicine doctor, I don't do traditional medicine. So as the functional medicine, direct pay doctor, I really stepped out of the box. And what was happening was patients who were failed by other doctors in my area were coming to me. And when I got them, well, they would go back and tell these doctors, and it didn't take very long, all over the internet. Well, horrible things written about me. I was being bad mouth locally, I was being bad mouth online. And then I couldn't believe it. But I got served with an investigation, I had to show up at the New York State Education Department because of my practices being accused of being unsafe and out of the scope of Podiatry. And I went through this three hour interrogation with this investigator, and then they sent the crew to my office to go through every room and talk to patients who were there. And at the end of the entire interrogation. I asked him, you know, so what's going on? He goes well, to tell you to some throwing out all of these claims. You're not doing anything illegal, you're not doing anything wrong. And you're certainly not practicing out of the scope of Podiatry because I see everything you do is related to what's going on here. And then I said to him, Well, am I allowed to ask you who put in this complaint? He says I'm really not at liberty to say, but I was kind of angry. So so well. Was it a patient of mine? He said I'm not at liberty to say. I said was it another local podiatrist? He said I'm not at liberty to say.

Dr. Kornfeld  20:00 
I see well, I'm really confused as to who this could have been other than my New York State Podiatric Medical Association, he knows I'm not at liberty to say, I couldn't believe I was paying dues to an association that was supposed to be there as my advocate. And they turned me in and tried to get my license taken away. So it was really the straw that broke the camel's back. For me, as far as dealing with other doctors and I, I really didn't want to deal with doctors, I didn't really want to, I'm sorry, I didn't wanna deal with podiatrist, doctors I did, because they were very kind to me. And they were helpful to me, and they were mentoring me, and they were sending me patients. But I think the other misconception is that with the patients who call, they don't understand when I say if I say we do not accept insurance, it almost sounds to them, like, You're not welcome to come to my office. And I think that's something that I became aware of after a while, because as soon as I said, we don't accept insurance, they kind of hang up. So I kind of had to spin it to what it really is. And when people call I say, you know, they'll ask me, do you take XYZ insurance, I'll say, I don't allow insurance companies to interfere with the care I give my patients. And that is a completely different communication, then I don't take insurance. That sounds like well, I only want people that have money, which is not true. I want people that need me, who understand that why I don't take insurance is to be a better doctor for them. And I think that made a big difference in in the way that the public sees me and receipts, what I say to them, because that is the reality. You can't be as good a doctor as you can be. While you're working through the insurance system. You have to work fast, and you have to work according to what they want you to do.  And I used to go crazy looking at trucks going well, let me see what insurance they have. So I know what I'm allowed to do.

Dr. Tea  22:09 
Yeah, we became the intermediary, the doormat, because we have a door, we have a face, insurance companies just have a phone line that hangs up on them. So we become this part of the care that really isn't what we drempt medicine would be. So I can agree. And I really love how you said how you reframed what patients are always going to ask, do you take my insurance? And I have a similar thing. I tried to spin it in a way but I think yours is much more eloquent in clarifying why not only that you don't fill insurance, but why it's important that you don't. So I hope people catch on to that we listen, if you missed it, it was really beautifully written out. I saw it on your LinkedIn and you're seeing it again here. So thank you for your your aversion, it's quite beautiful. I wanted to give you the opportunity to talk about functional medicine from a podiatry standpoint, because I have always valued holistic care, I just didn't have the I didn't know how to articulate it. Because a lot of our training, especially in this day and age, our training is focused on surgeries and trying to find parity with other professions. And if you're a podiatrist, listening, listen close to this because I think this is a portal to opportunities to really practice medicine the way it's intended. And if you're not a podiatrist, and you're a specialist, and you're listening in, stick around, because we are collaborators and patient care, and we have a lot to offer to. So Bob, why don't you tell us a little bit about what you're doing now with your time in your course and what it offers to people.

Dr. Kornfeld  23:45 
So after 36 years of practicing functional medicine, which let me just define it quickly. For those that don't know what it is. We don't just make a diagnosis and jump into treating symptoms. We make a diagnosis and then we have to answer the question, why this patient at this time? What caused this patient across the morbidity threshold and why are they here? So I can diagnose plantar fasciitis, but the question is, why do they have it? So I lectured to some residents not long ago and I asked them what causes plantar fasciitis. And they gave me a million biomechanical you know diagnoses. So so what you're telling me is everybody with gastroc, soleus Aquinas or rearfoot Varus, or forefoot Aquinas is going to develop plantar fasciitis. And we know that's not true. So we have to look at the underlying mechanisms. What's burdening the immune system? What's making it impossible for the repair pathway to power its way to healing. So we look at all the different systems of the body that have an interplay with each other, that may or may not cause immune burden. And the first thing we have to do is go outside the foot and look at the patient's epigenetics, diet, lifestyle and environmental issues. Then we decide through the symptoms we see through the medical history, the family history and the review of systems where we have to lean our diagnostic lab tests to. And once we have all that information, then we can come up with a plan, a treatment protocol to start unburdening the system so that we can get to immune efficiency. And then we can push the healing with regenerative medicine therapies. So it's really a way to heal symptoms, but also uplevel, the health of the patient, so we're much less likely to see them in the future with downstream drama caused by the same unaddressed mechanisms.

Dr. Kornfeld  25:51 
So I have created the Institute for Functional Podiatric Medicine. It's for podiatrists that want to incorporate functional medicine into the practice of podiatry and do the kinds of things that I've been doing, and use that powerful niche to go direct pay. Because it does give patients a very compelling reason to pay out of pocket, because you'll be doing things for them that no other podiatrist is doing. You know, everybody that's rushed for time is going to come into the room up plantar fasciitis cortisone shot, and say to orthotic PT, see you later. And we leave all these underlying mechanisms unaddressed. And there's so much to learn about the human body. And in functional medicine, we learn what's happening in one cell of the body is happening in every cell of the body. So you can't divorce the foot from the rest of the body, you're still treating a human being.

Dr. Tea  26:46 
And direct care allows you the time to even think about deeper questions like why?

Dr. Kornfeld  26:55 
Excellent point, excellent point, because you need a lot more time with your patients to practice this way. But when you aren't getting paid $8.04 for a one hour visit, you can afford to be a more thorough and comprehensive doctor. You know, the reason I keep putting down insurance is because they deserve to be put down. They're destroying medicine in this country. They've destroyed access to care, they pretty much taken every doctor that's practicing through insurance, and destroyed their self esteem and their self value. And they all walk around hating what they're doing, and they're miserable. And that gets transmitted into the patient's encounter, whether they believe it or not. Right. And this is no way for our country to come back from what's happening. I mean, the metrics of American medical care are just horrible, in spite of all our technology, in spite of the enormous amount of money being directed toward health care, because we're not really caring for anybody's health. Functional Medicine addresses that beautifully.

Dr. Tea  28:03 
So how would you help other doctors market themselves? What worked for you, you said it took you about a year and a half to get going to market your cash practice.

Dr. Kornfeld  28:13 
I started locally. So I just reached out to every holistic doctor that was in my area, and I introduced myself and I went there with brochures and anyone that let me in the near office, I would sit down with them, I would tell them what what I'm doing how I'm doing it. And if they have any patients that, you know complaint of a foot or ankle problem, you know, please send them my way. And you know, I was creating cross referrals with pathology that was out of the scope of Podiatry. So that's where I started. Then as I started to go to more and more seminars, I happen to be a very outgoing person. I just walked up to anybody who's signed, said New York, and introduced myself and got connected on a lot of levels with doctors who would refer to me who understood what I was doing. And that was how I began. Then I started doing public lectures, I started writing articles and getting published in all different kinds of magazines. And the thing that really turned things around for me was I got my own radio show. And it was an interactive 30 minute show, I would speak about a couple of different topics. And then I would take live callers. And once people hear your voice, it really makes a difference. Once they understand where you're coming from, and they get a sense of what you're all about. They're more than happy to come. Yes, undoubtedly some people won't come because they feel that they just can't afford to spend a nickel. But the people who come in may say to me, Well, I don't know. That's a lot of money. And I'll ask them well, you know, are you going out to eat Friday night? Yes. Where are you going? Oh, we're gonna get steak in this and that, well, you know, you're going to blow $300 And that food is going to be gone tomorrow. And it's going to be adding to the pathology load that you have in your body.

Dr. Kornfeld  29:40 
Maybe you don't go out to eat saved For $300, bring it here and get well. And they look at me and they smile and they go, Okay, you're right. But you know, I have the advantage of having been doing this for 23 years, I know how to speak to people, I understand the pain points that most Americans have with money I honestly do. And I do my very best to create a treatment protocol. That makes sense to them. But I don't work for free, I don't work for insurance rates, I would go out of business, I'd be bankrupt in no time. So we do make a very nice living in direct pay, we have a lot less stress, our expenses are infinitely lower. And patient access is immediate. Most of the time, I can get anybody in the office on any given day, if I'm, if I'm in the office, because I'm not loaded up with 60 patients anymore. I don't need to be, you know, there's no, there's no reason for it. It doesn't lend itself to effective care on any level, you know, I know the dogs that love to do surgery, that's great. You know, go to the hospital, have your fun, do all your surgeries. But in reality, the things you're correcting can work in tandem with the functional medicine approach, because it would diminish a lot of the complications we see postoperatively. Preparing your patients pre-op makes so much sense. If you're operating on someone that lives on Twinkies and cupcakes, they may not heal as well as someone that's got a corrected diet and, and their immune system is perky. So it's not just for people that want to do Podiatric Medicine, it's for everybody. It's for all the doctors out there, that even the ones that love surgery would benefit from this and so with their patients, and you can create a hybrid practice, where you're doing insurance on some days and the other days, you're doing direct, because much of what I do isn't covered by insurance anyway. Which is, which is fine with me

Dr. Kornfeld  30:57 
For the person who is unclear on whether or not you're happy about your insurance for your practice, I think it's fair to say you're, you're pretty perky about it.

Dr. Kornfeld  32:16 
I've been a very happy Doctor all through my career, except I would say I think I was participating in managed care about eight years. And it drove me crazy. They really did. I wasn't happy. I wanted to quit. I just felt burdened and stressed and I saw no way out of it. The trajectory, it just was getting worse and worse and worse. And I don't want to hang around for that. I thought more of myself than that.

Dr. Tea  32:42 
So for the doctor who's on the fence about leaving insurance, what would you advise them? What would you say to them?

Dr. Kornfeld  32:48 
They should call me and have a conversation, because a lot of the fears, a lot of the fears that they have are invented by the insurance companies, and they buy it hook line and sinker. It's it's not the way most people think, you know, any? Every time a doctor says to me Will my patients won't pay me? I said, Well, of course not. Why would they you're accepting their insurance. See what happens when you stop accepting their insurance and start doing things that other doctors are not offering. Then all of a sudden you become valuable. I don't know if I should bring this up. You might want to cut this out. But I used to share an office with a plastic surgeon. And people will coming in and paying him untold 1000s of dollars just to have a nicer nose or bigger boobs or better lips or ears. I know whatever they were doing. And my patients would say $20 copay Dr. So and So around the corner doesn't charge the copay. And I was complaining to him one day, and he said to me, Well, you're only worth the $20 copay. What can you expect? You have to be expensive for people to value what you do. And I really took that to heart because he was right. You know, I'm not killing people with my fees. But if you compare it to what insurance pays, of course, it's expensive. But like I said, in the long run, it's a lot cheaper than what people are dealing with. They just don't realize it.

Dr. Tea  34:17 
Yeah, there's a couple of things in there that I see. Because when you're self selecting for people who already don't want to pay by taking insurance, and then you also conditioned people to not pay because you say you're going to build their insurance and then you'll get paid months later and I've gotten paid a year and a half later for surgery and then I've gotten Medicare just sent me a note saying I want the money back that you did a service three years ago. Can you imagine going to a restaurant and doing the same thing and saying I ate something three years ago now I have gout it's just medicine. It's always an exception. And it's it's a bad model.

Dr. Kornfeld  34:53 
It can be fixed. You know here's here's the way I see it. If done Doctors stop participating. We can disempower insurance companies. Once insurance companies are disempowered, one of two things are going to happen. Either the government will step in and come up with a better program, or insurance companies will say, Okay, we're sorry, we're not going to exploit and abuse you anymore, we're just going to do it this way. And you'll, you'll have a much easier time of it. Or people will start to realize that, you know, if I add up all the dollars I spent on non covered services and deductibles, and co pays and premiums, I'm better off going and paying out of my pocket and buying a catastrophic plan. That to me would bring medicine back to free market where it was when I went into practice, and it was beautiful. There was nothing else what was going on, and everybody got taken care of, we only had to see about 20 patients a day. And nobody complained. And everybody was able to get an appointment with me with within a week. But then it got to the point where people would call my office and my receptionist will say, Oh, he it was April, they would call Oh, he could see you the end of June. How am I supposed to help people that can't even get in?

Dr. Tea  34:57 
Do you think this is gonna happen in your lifetime?

Dr. Kornfeld  36:19 
Well, here's what I will say. I've been connecting with lots of people on LinkedIn, as you know. And the pain points are not just podiatrist, every physician out there, they're all miserable, their old burden, they're all stressed, and they're all ready to just throw in the towel. So I think there is a an organic movement happening, because it's just too much. It's how much can you take before you break? So I don't know. I plan on living till at least 100. So I'll say it will happen in my life.

Dr. Tea  36:54 
Well, if people want to connect with you, what's the best way for them to find you and your course?

Dr. Kornfeld  36:59 
Well, to review the course you can go to the or they can email me directly at It's just Dr. Robert Kornfeld with a  k @

Dr. Tea  37:16  
And I'll be sure to put that in the show notes. Thank you so much for your time. It's always a pleasure talking with you.

Dr. Kornfeld  37:22  
Same here T. Thank you.

Dr. Tea  37:25  
And for everybody else. Thank you for sticking around. I know this podcast is not just for podiatrist, it's for all specialists interested in saying goodbye to insurance because we can all have the same common enemy. And we collaborate to take care of our patients. We take care of the feet, you guys take care of everything else. So thank you so much for your time. With us here today. I will catch you in the next episode. Take care.

Dr. Tea  37:47  
Thank you so much for being here with me. If you enjoyed this episode and want to hear more, please like, share and subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect find my info in the show notes and send me your questions. That might be the topic for future episodes. And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time