This is a difficult letter to write. I graduated as a podiatric physician (foot doctor) in 1992. When I finished my educational programs, I sustained a college loan of over $148,000.

Becoming a podiatric physician is a long and difficult educational process and is very expensive. Nobody in my family could aid or support this effort. Our profession is proud to help protect people with severe circulatory diseases and diabetes from amputations of their feet and legs. Often the trip to the podiatrist is the only thing that separates such patients from death, because studies have indicated that most victims of amputation die within 6 months to a year.

My school loan is in default. The "news media" image of such individuals is that of waste and high living. That could not be farther from the truth for me and my family. We have an 8 year old car. We never go to restaurants or eat out. We have taken on a lifestyle of poverty, going to thrift shops and only sales. If you wish, I will send you a copy of my last year's tax statement (optional). If I have to pay a malpractice premium of over 14,000 dollars/year and have a 1800/month school payback loan, how can I pay it back? Could you?

You might reasonably ask why some podiatrists are able to pay back their loans. There are many reasons for this. Most commonly, their families were able to help finance their university education, so they started out with much smaller debts. Many are in a state of "chronic forbearance." For them, the loans and debt just rise year after year, and a situation of permanent servitude develops-but their loan is not technically "in default." When you think of it, this condition is astonishingly close to the middle ages relationship of serfs to their landowners.

Here are the parallels:

The key elements in this relationship is the inability of health care providers to:

1. Obtain income from other sources to get out of the "contract"


2. Forced into usurious contractual relationship that cannot be dissolved until death-bankruptcy not permitted


3. Terms of the implied contract have been changed without the consent or even the awareness of the borrower-the implied. contract was the premise that education was our key to prosperity.


4. Conditions of usury
   
 
5. Substantially reduced compensation designed to keep the borrower in a perpetual condition of servitude

Podiatrists are a needed profession. We contribute to the public good and health. Already some podiatry schools may be closing due to decreased enrollments. The cutbacks from private managed care and Medicare are the main reasons.

THE GOVERNMENT CANNOT HAVE IT BOTH WAYS. IF YOU
REDUCE DOCTORS' INCOME BY CUTTING BACK ON
MEDICARE AND ENCOURAGING PRIVATE MANAGED CARE
(AND HMO PROFITEERING), HOW CAN YOU EXPECT
DOCTORS TO PAY BACK THEIR COLLEGE LOANS?

This is what I am requesting from you:

1. At the present time, pay back of college loans is not tax deductible. Big business gets enormous tax benefits by offering stock options to their employees. Some large corporations pay almost no taxes. Small businesses gets almost nothing. Our family respectfully requests that you support tax deductibility for college loan paybacks.

  

2. My college loan is in default. I am requesting that you contact __________ and let them know that you recognize that governmental actions have lead at least in part to the reasons why I am in default. I request that you intervene to help me arrange a much smaller repayment schedule and stop the lawsuit against me and my family.

  

3.  Please don't always grant your unquestioning support to managed care. Our society still needs doctors. When you and your family are aged and possibly in a nursing home, the person who tries to provide foot health services to you (like cutting your nails and trimming calluses and ulcerations) might not be educated. Instead they may not speak English and will be paid less than minimum wage. I once recall seeing a patient in a nursing home who had an aide trim their nails. During the "effort" the neighboring toes "got in the way" and some of the toes were almost literally amputated. The patient was in a semi-fetal position, and it was difficult, but that's what can happen. It's an understatement to say that the lay public does not understand podiatry. It's axiomatic that anything not understood is devalued. 

  

4. Slow and rejected (but appropriate) payments from Medicare and private insurers threaten my ability to pay my school loans. Many privates are reducing their payments to the point where they don't even cover my office expenses. Medicare delays and refuses payments for services that should be paid in a timely fashion. A plumber or appliance repair person receives a greater fee for making a house call than a podiatrist. In the future (or enclosed) are issues I have with Medicare for which I need your help. I will be requesting that you call and question Medicare why they aren't paying these reasonable, contracted services.

  

5. I will be often in contact with you regarding these important matters. I respectfully request your indulgence and help now and in the future. Our family is at stake. I was always trained as a youngster to "pay my bills." I wish to continue with that honorable tradition. As you may know it is almost impossible to discharge college loans in bankruptcy. Perhaps that's as it should be. But I think when government excluded student loan bankruptcy, it was in reaction to graduates buying expensive cars and living the life of Bill Gates on the backs of their government loans. I laugh out loud if anyone thinks this applies to me. But in order to fulfill my obligations, I now need the help of my legislators. I can no longer do it alone.

  

6. I think if a family can demonstrate that they have lived penuriously over say a 10 year period after school and cannot STILL pay back their college loan, they should be permitted liquidation of it. Protections can be put in place. Their tax returns over the 10 year period could be examined, as well as their spending habits. We're talking about honest suffering here, not the government becoming a loan shark, with the life of a medieval serf being their goal for me and my family. We sincerely appreciated being granted the loans, but I respectfully urge you to remember that it was GOVERNMENT that decided to halve doctors' incomes.

The "myth" of the wealthy physician is gone. In Silicon Valley, board certified orthopedic surgeons cannot afford to buy even condominiums. This "myth" has attracted talented students to enter podiatric and allopathic medicine. Our generation of providers was given a false promise. We were already entrenched
in our lengthy training programs when government and big business made their decision.

Had we known this in advance, we probably never would have started on this road to contributing to the health of Americans. But for many of us it is too late. Our enormous loans are a legacy of a time past that will never happen again in our lifetime.

That is why our family is requesting your help and assistance.

Respectfully,
Doctor large loan, DPM