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03/13/2018
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Estelle Albright, DPM
I am surprised from the survey that so many podiatrists are still grinding nails. To those podiatrists who are still grinding fungal toenails: Please consider the considerable risks to self and staff caused by nail grinding: lung granulomas, and fungal sinus or lung infections caused by aerosolization of fungal nail particles or spores. Also, consider the risk to staff for cleaning, disinfecting, and sterilization procedures of re-usable burrs.
I am of the opinion that we, as physicians, should instead treat the infection medically or surgically. There are many safe oral and topical antifungal meds available, as well as surgical treatment of fungal nails. If none of these are an option, consider double action bone cutters to debride thick nails. These do a very decent job on thick, hard nails and are easier on your hands. For ingrown edges, Miltex 40-22A ultrafine nail splitters are excellent for simple nail edge avulsions.
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Estelle Albright, DPM, Indianapolis, IN
Other messages in this thread:
07/03/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Wenjay Sung, DPM, Joel Feder, DPM
Congrats on the name change and new logo, but what color blind agency came up with this color by committee scheme? It’s like if old podiatrists asked AI “what colors do young people like?” but vomit green and puke yellow were already taken. But congrats on the name change.
Wenjay Sung, DPM, Arcadia, CA
I agree with Dr. Steinberg's Congratulation on the change of the "Illinois Podiatric Medical Association" to the "ILAPPS". But why is the logo missing the "Winged Foot" on the caduceus? And in keeping with modern medicine, it should really be "The Staff of Aesculapius with a Foot".
Joel Feder, DPM (Retired), Sarasota, FL
07/02/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Robert Scott Steinberg, DPM
I am shocked that more 50% of respondents think "podiatrist" is a good enough descriptor. I wonder what their average age is. Were the respondent DPMs from the U.S. or podiatrists from other parts of the world?
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ILAPPS logo |
In January, the Illinois Podiatric Medical Association began doing business as the Illinois Association of Podiatric Physicians and Surgeons (ILAPPS), and with it, we adopted a beautiful new logo.
Robert Scott Steinberg, DPM, Schaumburg, IL
05/03/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Ivar E. Roth, DPM, MPH
I read Dr. Kesselman’s response. While I understand his thinking, here are my old school thoughts concerning student loans. Any student can easily reduce their loan dependence by working part time during their schooling or on summer breaks. Also decreasing debt is easy; spend less and scrimp during school and residency. Too many students today think nothing of drinking $6 Starbucks whenever they want and living above their means. Maybe you must reduce rent by sharing an apartment.
There are lots of ways to spend less and or supplement your income. There is nothing wrong with a little struggle but today’s students to me seem to be entitled to a certain lifestyle that maybe they can’t afford. What I am trying to say is that where there is a will there is a way. The same goes for wanting to just get a 9 to 5 job. If you want to really excel, try the concierge/ direct pay model, and make as much as you feel you deserve. Yes, it will be difficult at first but in the long run, you are the boss of your future not just an employee happy to get yourself a cost of living increase each year.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/02/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Paul Kesselman, DPM
Recently, I met a young intern doing his PGY-1 prior to starting his five-year residency in general surgery. He is faced with almost $400K in debt from medical school and more from undergraduate school. Between the two, he can easily amass $600K or more in debt. A neighbor graduating from high school will amass $500K in debt from his undergraduate degree and then more from his anticipated pursuit of a legal degree.
It is no wonder that more and more young students are moving away from traditional degrees in healthcare and moving to shorter degree paths with easier career paths. PA and NP are far shorter than MD/DO and DPM degrees with much less stress, easier lifestyles, and nice salaries. Nurse anesthestists command $150+ salaries after a four year BSN and a year or two of...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/02/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A
From: Shashank Srivastava, DPM
I understand the points that Dr. Hofacker is making and all are very good. That said, I personally feel that it is not reasonable to expect 17 year old high school kids to want to know they want to be podiatric surgeons at such a young age. I remember how I was at that age, and no way could I have made such a commitment. I think a certain level of maturity and some life experiences are required before making this commitment.
The problem is if they decide at 22 years of age that they want to do something different (common sentiment among that age group), there is no turning back and lots of debt and possible resentment. Unlike allopathic or osteopathic physicians, we cannot just simply change specialties and do different residencies and fellowships. There is no turning the ship around.
Shashank Srivastava, DPM, Rockville, MD
05/01/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Rich Hofacker, DPM
I was surprised when I read that only about 1/3 of our profession is in favor of a 6 year college/podiatry school option. In an ideal world, a 4 year undergraduate degree, a 4 year podiatry degree, followed by a 3 year residency would still be preferred. However, it is not an ideal world any longer. The enrollment in our podiatry colleges is down, which means the selection pool for good candidates is not good and some of the schools may have to consider closure, if the current situation does not reverse itself.
I have 4 children, all of whom had the bedside manner and the work ethics to become outstanding physicians. However, they all chose different career paths, which is more than fine, but it is the reasoning behind their decisions which still bothers me. The two main reasons that they told me for not considering medicine/podiatry were the cost and the amount of extra years of schooling.
I think that we need to still investigate the 6-year college/podiatry school option. We may be losing some good potential students to carry on in our noble profession.
Rich Hofacker, DPM, Akron, OH
03/26/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Steven Finer, DPM
This week’s poll covers disability insurance. As to new practitioners, when you buy this product make sure you understand the meaning of disability. For example, some policies may state that should you have a life-threatening situation, you could still teach and therefore be denied coverage. The policy should state that upon the fact of not being well with a serious medical condition, you will collect. Years ago, I bought the wrong policy, and a few years later turned that in and bought one with the proper definition.
Steven Finer, DPM, Philadelphia, PA
03/19/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Kristin Happel
Once again, I am astonished and disheartened by the lack of preparedness on the part of providers to deal with a crisis involving their income. Did anyone not learn anything from the COVID shutdown in 2020? As a rule of thumb, each practice should have 3 months or more of income set aside in order to deal with any adversity that may befall a practice...such as a pandemic, or a cyberattack on their clearinghouse, or anything else that can be imagined. This is the same financial advice given to anyone who has a job they count on to pay their living expenses. I have 3 or more months of income in savings. I know I do, and I am not a doctor.
I know the running "joke" is doctors make the worst business owners, but this is ridiculous, in my opinion. If you own a practice, you better make sure you are a good business owner, or you don't have any business owning a practice. I have been reading in the news recently that various practices are going to have to close down/let staff go, because of the...
Editor's note: Ms. Happel's extended-length letter can be read here.
02/28/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Pete Harvey, DPM
I was somewhat taken aback to read that almost half of the profession is paying over $450/month for EHR services. In every journal I read, at every meeting I go to, and in personal correspondence, this topic is never discussed. It might be interesting to begin a discussion concerning the various ramifications of EHR cost and implementations.
Have any readers been through the process of your program being sold without your knowledge until you get a call or email stating that your program has been sold to another EHR provider? Then, you must continue with the new provider or find a different one. This topic, and those related to it, should be on every podiatry program in the country. We might begin here. If you discuss a particular EMR provider, it’s probably best to delete the name.
Pete Harvey, DPM, Wichita Falls, TX
07/28/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Joe Agostinelli, DPM
The question asked about emeritus status for certifying boards is not a yes/no/unsure type choice. I retired from practice in 2017, which coincidentally was my year point to recertification for ABFAS. I was board certified in 1987 went through the certification process every 10 years. I contacted the board and told them I was retiring from practice and received a letter from the ABFAS stating I had “retired” status with the board.
If I ever wanted to return to practice and activate my board certification, I was told I would have to take the required CME, complete the recertification process, and pay the annual fee. This seemed appropriate to me. Emeritus status makes sense for the fellowship status of ACFAS, AAPSM, and ACPM but should NOT be offered by the certifying boards. Emeritus status, in my opinion, for the certifying boards is misleading to the public, especially as to someone years from retired practice. It doesn’t have anything to do with the years of paying registration fees for maintaining board certification status. The certifying boards have processes in place for regaining active board certification status and have a “retired “category for those fully retired from active practice.
Joe Agostinelli, DPM, Niceville, FL
06/20/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Don Steinfeld, DPM
I answered last week’s question of what the greatest existential threat to podiatry is with ‘other’. My feeling, as an ‘85 graduate, is that a lack of unity among us is the key. No obstacle, including the insurance industry and the government, is insurmountable IF we act as one. Together we could wield a mighty sword.
We surely can all find reasons to complain about our leadership. But it’s our leadership. How terrible the lack of involvement of young practitioners is! Don’t miss the forest for the trees. Our profession has made spectacular progress. The APMA is our voice and our sword. My late father-in-law was a factor in optometry’s success in expanding their status and privileges versus opthalmologic opposition. This has benefited my wife who followed him in practice. How did he do it? Leadership. Organization.
Don Steinfeld, DPM, Farmingdale, NJ
06/15/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Richard M. Maleski, DPM, RPh
In my opinion, the biggest threat to podiatry is the fact that we are still not considered physicians in all senses of the word. All of the other issues with intramural bickering, insurance problems, etc. are not specific to podiatry. All medical disciplines face these issues, and they all fight each other and many "eat their young," not just podiatry. But until we can be recognized as physicians legally, we will never be able to fully participate in all aspects of the healthcare industry.
I don't know how we achieve that, whether it be a degree change along with the appropriate changes in our education, or a change in the way our post-graduate education is currently structured. Although many, if not most of us, are considered true "doctors" by our patients and MD/DO colleagues in our communities individually, we must be able to be legally classified as equals as an entire profession before we can expect to be reimbursed equally or be in positions of leadership as other physicians are. I think that this is also the main reason we are not attracting more young people to our schools.
Richard M. Maleski, DPM, RPh, Pittsburgh, PA
06/14/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Patrick J. Nunan, DPM, Steven Kravitz, DPM
I find it interesting that a person commenting that the profession itself is its own biggest threat, once testified against ankle privileges for podiatrists on behalf of orthopedic surgeons in his state. At that time, I was vice president of that state association and heard his testimony firsthand. Was not the question asking for forces outside of the profession?
Patrick J. Nunan, DPM, Beaufort, SC
Dr. Tomczak points to an age old question that faces not just podiatry, but all fields of medicine. There's too often a disconnect between the pride of being in medical practice, the economics that drive that practice, and the realization that all of us have a limitation of education. At the end of the day the primary focus must be whatever is best for the patient.
I just had a paper accepted by The Journal of Wound Care (due October 2023) that addresses this very issue. It describes a simple vascular procedure that went wrong, causing...
Editor's note: Dr. Kravitz's extended-length letter can be read here.
06/14/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A
From: William A. Wood, DPM, MPH, Robert Kornfeld, DPM
The greatest existential threat to our profession is the lack of a national practice act license uniting the profession.
William A. Wood, DPM, MPH (retired), Chicago, IL
Other than the fact that podiatry has never been a cohesive unit, I believe the biggest existential threat is participating with health insurance. There will be no end to the erosion of income over time. Podiatrists work like dogs and are being exploited by insurance companies. So who is to blame? Clearly, insurance companies because they figuratively rape doctors. BUT, this is not a new story. It is the continued participation/cooperation/acceptance of this madness that is also to blame. And that is something every podiatrist can change. Otherwise, they can continue working as the underpaid employees of the insurance companies that they are.
Robert Kornfeld, DPM, NY, NY
06/13/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Rod Tomczak, DPM, MD, EdD
The biggest existential threat to podiatry? For the last 50 years, we ourselves have been the biggest threat to the profession. I remember being in school in the early 1970s hearing the statement, "Podiatry eats its young."
It seems like there is always an intra-podiatry conflict of some kind. More often than not, the strife revolves around surgery, board certification, and extent of privileges. We, of vintage age, remember the intra-podiatry lawsuit; one group of podiatrists suing another group of podiatrists. Then there was the formation of PPOs, and podiatrists were literally paid per capita to essentially do nothing for patients. To become a member of the PPO a podiatrist paid $10,000 to someone and then...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/01/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Gary Mantell, MS, DPM
I have been following the discussion of the various medications that are being used by some in their office for pre-operative sedation. I fondly remember discussing the selection of drugs for use in office cases with the chief of anesthesia at NYC’s St. Barnabas Hospital while I was a resident there in 1984. At the time, an entire issue of Clinics in Plastic Surgery was devoted to office-based surgery since plastic surgeons, like podiatrists, were among the pioneers in the field. One article, “The Selection of Drugs in Office Surgery” discussed the use of the various classes of drugs in the office setting.
I asked the question of him, if he were going to operate in an office, what would be the one thing he would use. His pithy answer was that the one thing he would use would be an anesthesiologist. He punctuated his advice by informing me that if you put it in, you had better be able to take it out. To this day, if my patient is overly anxious or fearful and might need pharmacologic assistance, they go to the surgery center. The results of the reader poll showing over 70% of podiatrists steering clear of in-office sedation appears to be consistent with that decades old advice. I have no desire to manage a potential adrenergic response to anxiety, fear, pain, or hyperstimulation.
Gary Mantell, MS, DPM, Memphis, TN
05/29/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Narmo Ortiz, DPM
While I cannot imagine that any practicing colleague would be against a uniform scope of practice law for podiatrists, first and foremost what needs to be achieved is national licensing uniformity and/or reciprocity for podiatrists to be able to practice in any state he or she chooses to call home.
Narmo Ortiz, DPM, Davenport, FL
05/25/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: William A. Wood, DPM, MPH
Until there is license parity among all podiatrists, there will never be parity with our allopathic and osteopathic brethren.
William A. Wood, DPM, MPH (Retired), Groveland, FL
05/23/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Ivar E. Roth, DPM, MPH
It is good to see that the vast majority of podiatrists support this concept. Now we must make it a reality. As podiatrists, we should be able to practice and obtain full scope podiatry licenses anywhere we want straight out of training.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
04/01/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Rod Tomczak, DPM, MD, EdD
I'm not sure how a single board for certification in podiatry would actually work out. Does that mean that after some unequal training, everybody would be approved by the "American Board of Podiatry", a hypothetical name, to perform whatever procedures he or she felt was within their personal scope of competency? Would that mean that after a weekend course in ankle arthroscopy, a podiatrist could perform arthroscopies at their hospital? A Lis Franc fracture dislocation could technically be called a forefoot surgical problem in some circles. Several of you know how difficult an ORIF of that condition can be and maybe have seen a mal-union of an improperly fixated Lis Franc during your career.
Is the purpose of one certifying board to allow a podiatrist to operate on whatever they felt capable of doing? Or is it to equate the training of a podiatrist who has performed...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
03/24/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: H. David Gottlieb, DPM
There is a free app called Doximity that includes a dialer function. When you set the program up, it allows you to insert your office phone number. When you call someone through this app, it appears as if you are calling from your office.
H. David Gottlieb, DPM, Columbia, MD
03/23/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Burton J. Katzen, DPM
I have a separate cell phone (not my private one) that I give to patients, especially post-op patients or patients that I feel need to get in touch with me in a timely manner (ex. diabetic ulcer patients). I will put their name, date of surgery, and type of procedure in my contacts so I know exactly who is calling and when and what procedure was done. I use a pay-as-you-go phone, and the total yearly cost is less than $75.00. I always contact my patients the 1st post-op day, and they know it is me calling.
The patients love not having to go through an answering service and getting me directly, and the cost compared to an answering service is minimal. It's almost like having a concierge doctor on call and I can't begin to tell you how many referrals I have gotten because of that practice. When the phone is off, (usually after the 2nd post-op day) I have it call forwarded to my private phone, but they will leave a message, so I still know who is calling.
Burton J. Katzen, DPM, Temple Hills, MD
03/22/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Jack Ressler, DPM
On occasion, I have given patients my cell number but not as the norm. A warning to fellow podiatrists when calling patients for various reasons. If you use your personal cell phone, they will have your number. This happened to a patient a few years back. I had called her from my cell phone to discuss the correct dose of a medication. She called me back the next day on my personal cell phone. My luck, this happened to be a long-winded patient who loves to talk. After listening to her troubles for 10 minutes, she finally asked if a dosage change in her meds would interfere with her incontinence. As it turned out, she thought she called her urologist.
Jack Ressler, DPM, Boca Raton, FL
03/21/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Elliot Udell, DPM
This is an interesting topic. First of all, we should all know that if we call a patient from a cell phone, they will most likely automatically have your cell number. Here is the problem: "Mr. and Mrs. John Jones" now has your cell phone number because you called them to see how they were doing post-op or you gave them the cell number to call in the event of a post-op emergency. They consider themselves "special" because they no longer have to go through your office staff to reach you.
Two months later, you are driving on the expressway and they call you on the cell phone, not for an emergency but to schedule a routine appointment and you have no way of documenting it as you are driving 65 miles an hour with both hands on the steering wheel. Another scenario is that you might be at a concert, a party, or someplace where you have to put the phone on mute and someone calls to schedule a routine nail clipping. They are upset because you did not pick up. Yes, in cases where I want a patient to be able to reach me in a hurry, I give them my cell number, but if they start calling for routine matters, I gently ask them to call the office during business hours.
Elliot Udell, DPM, Hicksville, NY
01/25/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Robert Kornfeld, DPM
Dr. Hofacker wonders what the MDs and DOs feel about practice. In fact, a 2019 Medscape poll of 15,069 MDs and DOs revealed that nearly half reported "burnout" with 11% suffering colloquial depression. Urology topped the heap at 54%. The reasons given were having to see too many patients and the redundant and maddening paperwork required by insurance companies. The lowest burnout rate came from solo practitioners at 41% burnout and up to 50% for healthcare organizations. Only 26% said they would recommend medicine as a profession to their children. I was unable to find a survey of chiropractors but perhaps one exists somewhere.
Robert Kornfeld, DPM, NY, NY
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