Most people when they owe money try to evade loan collection people. I suggest a complete reversal of that policy. Give them your home number. Tell them to call you whenever they wish. Write them letters every week or month on your financial "progress." Tell them you and your family live on almost nothing. Send them your tax records. Make Photostats of your state tax receipts for your cars to prove to them that you don't drive a Lexus. Send them a copy of your malpractice insurance bill. Cry on the phone when you speak with them. Send them copies of letters you have mailed to your legislators. Ask them if they have a family member who is a diabetic Tell them what happens to diabetics who don't have foot care. Ask them what those people will do when the last podiatrist goes out of business due to governmental actions.

Any podiatrist who is close to default or is in default should develop the THICKEST files of any and all healthcare practitioners. While I cannot and will not give legal advice, I can suggest that should your file ever go to a judge, a thick file showing that you have been trying your VERY BEST to pay back your college loans cannot do you any harm.

Example of letter to your loan officer who is dunning you:

Dear Loan Shark:

As you know from examining my file, my loan is in default. I know you are concerned that people like myself are living a life of luxury based upon delay or refusal to pay a loan that was generously offered to further my education. No doubt you have a few people among your files who have done that. I am grateful that these loans were allowed and understand the burden that I have willingly accepted.

When I entered podiatry school, after attending undergraduate college, podiatrists still made a respectable, and in some cases excellent income.

But the very government who's efforts you are now prosecuting has decided to halve (and worse) doctors' incomes. This comes in two forms, first a drastic reduction in Medicare payments, and purposeful delay and in some cases outright refusal to pay reasonable claims, and second managed care itself. Should my case ever go before an administrative court judge, I intend to fully show and document the extraordinary delays and refusals of payment that blocks my efforts to make a living and pay back my loans. Since podiatrists see a large share of Medicare patients, in effect, it is the government itself that is making my effort to pay back these loans almost impossible.

I was caught in a time warp. Managed care had not yet taken full effect and government hadn't yet decided to severely reduce doctors' incomes. Had I known this would happen I never would have chosen the difficult road to assist in the health of Americans. Instead I would have attended an engineering college or learned information technology. I could have gone to school for half the time, had far fewer student loans and been well on my way to a decent life.

The need to make those payments has caused us a draconian lifestyle. I say this not out of complaint, but to point out to you our efforts: Now, in order to attempt to pay back my college loans, my wife and family live a life of poverty. We never buy new clothes. I drive a car that's at least 8-10 years old. We do not go on vacations, a movie or EVER go to restaurants. We are willing to submit copies of my tax returns to prove it if you wish.

Gradually, the new "reality" is now entering the market. New applications to all medical schools is drastically reduced and probably several podiatry schools will close. If that's what you
want, that's what you will get. Eventually, when members of your family or you are in a nursing home, a person who does not speak any English and is paid less than minimum wage will attempt to "trim your nails, ulcerations and calluses." I have seen examples of this kind of care: neighboring toes "got into the way," and have been almost accidentally amputated.

When I go to a nursing home to treat such patients, I get paid less than the technician who goes there to change the air vents in the walls. And, the government watches my billing with an iron eye, with the goal to sending me to jail if I don't dot an I or cross a T on my chart notes.

This is what I intend to do to try to repay my loan: For the next 10 years I will live a life of poverty with no discretionary spending. I will prove it to you by mailing you receipts of my day to day living if you provide me a pre-paid postage envelopes. I will send you all of my financial information. I will give you my home telephone and you can call me whenever you wish. However, if I have to call you and it is a toll call, I will reverse the charges. If you don't accept
the charges, I will not speak to you. This is not out of disrespect, but my lifestyle does not permit any long distance telephone calls that I must pay. I will always be open to your suggestions on how I can pay back my school loan Creative ideas are always welcome. If you want me to come to your office to talk to you, you will have to pay me bus fare or for the gas. However, if you do this, I will be glad to come. You must understand that your office cannot obligate me to any additional charges of any kind, postage, telephone calls, anything. It is not in my budget.

I have always tried to pay my obligations. President Harry Truman never had much money, except when he finally left the White House. Yet, he never complained. The purpose of this letter is not to complain but simply to explain my situation and deal with its reality. I feel it is my obligation however to also point out to you that it is precisely the decisions by government that were made while I was still in training that have caused this reality. I look forward to a long and fruitful relationship with you and your office.

Respectfully,

SKINFLINT PODIATRIST

NEXT ISSUE: WHAT ABOUT ADDITIONAL COLLEGE LOANS TO PODIATRY STUDENTS?