06/02/2012    Allen Jacobs, DPM

Success Tips From the Masters (Bryan Markinson, DPM)

I would like to interject a personal
observation. Three years ago, a patient whom I
was caring for, on whom I performed a revision
surgery for a failed orthopedic midfoot fusion,
informed me that her daughter was a first year
student at one of the podiatry colleges, would
be visiting her for the Christmas holiday, and
wished to visit our office.

I met with her in December, 4 months into her
first year of podiatry school. At her coaxing,
her mother told her to ask Dr. Jacobs anything
she wished. Her first question? "How much
external fixation do I do?" I was a bit
surprised, and asked why she would ask such a
question as a student 4 months into her 1st
year. She responded that, "I know that it is
controversial."

Again, I asked why she would think that external
fixation was controversial. She informed me that
as a first year student, she already had
completed 2 courses, corporate-sponsored, at her
school, in external fixation. Really? A first
year student?

Her second question was " How many ankle
fractures do I do a year?" what? A first year
student?

I proceeded to explain to her that my practice
is not typical of the average podiatrist, and
that while I do a good deal of such things this
should not be her expectation. It was possible,
but not guaranteed.

Conversely, while I have the greatest respect
for Dr. Markinson, I suspect his practice is not
the average either. I suspect that he is not nor
ever has been a surgeon. He is one of our
brightest, but a surgeon, I think not.

Vision 2015 is a joke, and has been from day
one. Our profession requires competent primary
care podiatric physicians and competent
surgeons. I hold as much respect for Dr.
Markinson, Dr. Udell, Dr. Bakotic, Dr LeMont,
and many many other " podiatric medicine
experts " as I do Dr. Laporta, Dr. Schuberth,
Dr. DiDomenico, and many other podiatric
surgeons.

Dr. Soave is correct. Dr Markinson is correct.
We need both primary care and surgical podiatry.
Respect for each branch is critical.

The problem, as illustrated by my example, is a
failure of the schools or residency training
programs to encourage podiatric medicine. And
glorify podiatric surgery. This is the result in
no small part of the colleges and residencies to
allow surgical implant companies such as Zimmer,
Stryker, DePuy, Wright, and others to buy their
way into our schools, journals, and seminars.

If it were not for BAKO Labs, PAM Labs, ABH, and
a few others, medicine would have no standing at
our meetings or with our students and residents.

We need to change this paradigm.

Disclaimer: Dr. Jacobs is a consultant for PAM
Labs

Allen Jacobs, DPM, Sr. Louis, MO,
allenthepod@sbcglobal.net

Other messages in this thread:

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06/15/2012    Bret M. Ribotsky, DPM

Success Tips from the Masters (Bryan Markinson, DPM)

Maybe it is time for "outside the box thinking".
If you have been following the newest trend in
dentistry, make sure your not holding hot coffee
when you read this article:
http://soc.li/QIYeclk from the LA Times.

There are dental therapists who are filling the
role of dentist. They are filling cavities,
pulling teeth, and performing root canals. Due
to the lack of dentists or the dental profession
unwilling to lower their fees, the
entrepreneurial world has developed an answer.
Lower trained, lower paid people to provide the
care that is needed.

I believe we are at a precipice for our
profession. In the past, we moved from RPR, POR,
PSR12, PSR24, PSR24+ to a common training. Was
this the correct decision? Are we all
harmonized? Is the goal of project 2015 of
parity just a step on the path? If podiatry is
to move towards the MD degree, then the
specialty will be more medical, and surgery will
be a fellowship. We would have acceptance into
all insurance companies, no scope of practice
issues, etc.

If podiatry is to retain the DPM degree, then
the problems we have has for the last 50 years
will remain for the next 50 years. I'm proud to
be a DPM, and my life would not change much if I
were an MD, I would practice the same as I do
now (I'd just get paid better).

Many minds much smarter than mine have shared
their insight into this problem on Meet the
Masters (all for Free at PodiatricSuccess.com)
and many steps have been outlined from the
Masters, on how to take the next steps
regardless of the direction. But we must take
the first step.

In a very bold move, Dr. Barry Block submitted a
request to the APMA for a vote of the membership
on which direction we should take. Five states
supported this vote of the membership. I have
been told this was ruled against the by-laws, as
a vote for the MD degree is perceived to be the
end of APMA. This is ridicules. APMA would
evolve to represent those who become podiatric
physicians, like the ACC (Amer. College of
Cardiologists) AAD (American Academy of
Dermatologists) AAOS (Amer. Academy of
Orthopedic Surgeons).

With the new healthcare world forthcoming, there
is a greater influence in physicians extenders,
and maybe podiatry needs to change or adapt, as
you can be assured that some type of podiatric
therapists will be available in the future.

Bret Ribotsky, DPM, Boca Raton, FL,
ribotsky@yahoo.com

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06/09/2012    Robert Kornfeld, DPM

Success Tips From the Masters (Bryan Markinson, DPM)

Dr. Markinson is right when he says that we need
a unifying board for podiatric medicine.
However, I think our issue goes way beyond the
obvious. I believe it is our history
and "status" in the medical field that blurs our
vision. Ours is a profession of non-MDs. Like it
or not, that is a fact. We are NOT MDs.

Yes, we have grown tremendously as a profession
in terms of our training, but many have tried
to "prove" their worth in the field by turning
podiatry into brain surgery. This, I believe,
quelled the insecurity of not being a "real"
doctor. So we donned our scrubs and marched into
hospital operating rooms.

We created a certifying board that cultivates an
internal bias that has weakened, not
strengthened, our position in medicine. We are
fractionated, unaligned and are failing our
goals miserably. Our podiatric surgeons have
watered an elitist attitude, so much so that
podiatrists who don't perform esoteric
procedures are looked down upon as the modern
day chiropodists who are the reason that MDs
still consider us non-physicians (i.e., corn
cutters).

My opinion may not be gentle, but I submit that
every podiatrist in this country who believes
that surgery glorifies his degree and who
believes we need to get rid of non-surgical
podiatrists is suffering from a personality
disorder and is insecure beyond what his/her
position in "the hospital corridor" could ever
offer. Egomania is a cover-up for pathological
insecurity. I am not fooled by it.

I have been a part of this profession for too
long. I watched my podiatrist father battle his
own peers. This is a sad and self-destructive
profession. It is a profession that eats its
young and buries its pioneers without a eulogy.
It is a profession that bad mouths itself. We
don't see each other as colleagues, we see each
other as competitors. I have witnessed first and
second hand how hard many DPMs work at
belittling their peers to the public.

Guess what? You have done your part to foster
distrust of our profession by trying to put
yourself at the top of the heap.
Congratulations. If you really want to catapult
your standing in society, work on yourself. Look
inside and self-reflect. Belittling your own
belittles you. It's time to grow up.

Robert Kornfeld, DPM, Manhasset, NY,
holfoot153@aol.com