05/08/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS) - PART 1B
RE: Dr. Lidtke's Remarks
From: Robert Scott Steinberg, DPM
I can understand how a soft shoe can attenuate GRF impacting the knee. I also understand that an overly soft shoe can exaggerate internal leg rotation at the knee in the presence of excessive subtalar pronation. I also understand that when you off-load one area of the knee, you do so by loading another. What I don't understand is what the OA Shoe does that others will not?
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com
01/15/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: The Residency Shortage
From: Tahir Khan, DPM
This month’s Podiatry Management magazine includes an article that I authored titled “The Residency Shortage and How to Succeed.” This article provides "Top Ten Pearls from the Residents and Residency Program Directors” to podiatric medical students on how to successfully secure a residency program in these tough and challenging times. I suggest all current podiatric medical students and past graduates searching for a residency program to please read and benefit from the article.
Tahir Khan, DPM, Brooklyn, NY, tahir.khan.dpm@gmail.com
01/14/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: The Residency Shortage (Richard H. Lanham, DPM)
From: Barry Mullen, DPM
With respect to Dr. Lanham's recent post, I offer the following FACTS: 1) My son's best friend graduated Vanderbilt University in 2012 with a 3.9 GPA. He is a very personable kid. He scored a 37 on his MCAT, a PHENOMENAL score! He received one medical school acceptance at UMDNJ (the state school where he's from) and was wait-listed at just one other school, which ultimately accepted him. 12 other medical schools, including Vanderbilt, where he matriculated as an undergrad, rejected him!
2) My son graduated Emory University in 2012 with a 3.8. He took one "gap" year and has applied for the 2013 medical school entrance class. His MCAT score is lower, but still respectable. Thus far, he has been granted just one interview and...
Editor's note: Dr. Mullen's extended-length letter can be read here.
01/12/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS) - PART 1B
RE: Residency Shortage (Ivar Roth, DPM)
From: Simon Young, DPM,
Thank goodness Dr. Roth has acknowledged a problem that I have been highlighting for years. Believe me, I have received a lot of heartache and letters.
Simon Young, DPM, NY, NY, simonyoung@juno.com
01/12/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS) - PART 1A
RE: The Residency Shortage (Paul Kruper, DPM)
From: Trevor Neal, DPM
I have dealt with the residency shortage issue firsthand. A couple of years ago, a recent graduate contacted me stating she had matched for a residency with the Army, however because she had skin cancer (which was successfully removed 4 years prior), she did not qualify for the program since the Army required her to be cancer-free for 5 years. In her graduating year, 20 students did not get a residency, and the following year was even worse, making it nearly impossible for her to match. It would be like trying to get drafted in the NFL after being out of college for a year. When she contacted me, she was working for a grain company for $12 per hour with her student loans bearing down on her like a freight train.
Since our group has 4 doctors and 4 clinics, I felt we would be able to generate enough cases to qualify for...
Editor's note: Dr. Neal's extended-length letter can be read here.
01/11/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
Residency Shortage (Paul Kruper, DPM)
From: Ivar Roth, DPM
While I am in complete agreement that there should be a residency for every “qualified” graduate, upon closer inspection of the “problem”, my observations are from offering a preceptorship program for those who did not get a residency (usually failed boards) and from interviewing recent graduates. The recent graduates who have not passed the boards should have been told somewhere through podiatry school that they were not compatible with being a doctor. Some of the students that I have spoken with and observed are just plain slow mentally, under-motivated, or have a significant mental/social disorder/problem that is not compatible with them actively entering practice.
I realize that the schools are under pressure to matriculate students, but it seems that the bottom percent or two should have been washed out somewhere along the line instead of doing them and the profession a disservice by graduating them. The bottom line is that the schools need to make sure that they accept only qualified students, beyond some minimum requirements, and have a mechanism to make sure that “problem” students somehow are identified and a process is in place to deal with them, even to the point of returning their tuition. While I do not like bringing up this subject, it is real and our profession needs to deal with it.
Ivar Roth, DPM, Newport Beach, CA, ifabs@earthlink.net
01/10/2013
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS) - PART 1A
RE: The Residency Shortage (Paul Kruper, DPM)
From: Richard H. Lanham, DPM
Firstly, podiatric medicine was only short 60 residency slots this past year to have everyone placed. Secondly, allopathic medicine has far more problems with placement than does the profession of podiatric medicine. Unless students have a 4.0, they are not going to be able to obtain their first selection, and are going to their second to fourth choice to obtain a residency.
Allopathic and osetopathic medical schools are expanding at a phenomenal rate in the U.S. There are so many schools that it is obvious to any educator that quality students will no longer be filling our medical schools. Your profession is working very hard to see that a three-year residency is available for all students. The Council on Podiatric Medical Education of APMA will not allow additional colleges of podiatric medicine to open until all capacity for current students is fulfilled. Is it a tragedy for current graduates? Yes, I believe so. Is the profession trying to resolve the issue? Yes, it is. Under the Affordable Care Act (Obamacare), we have only seen the tip of the iceberg.
Richard H. Lanham, DPM, Indianapolis, IN, shirley.lanham@att.net
06/15/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips from the Masters (Bryan Markinson, DPM)
From: Bret M. Ribotsky, DPM
Maybe it is time for "outside the box thinking". If you have been following the newest trend in dentistry, make sure you're not holding hot coffee when you read this article from the LA Times.
There are dental therapists who are filling the role of dentists. 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 are providing 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...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
06/13/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips from the Masters (Bryan Markinson, DPM)
From: Gary S Smith, DPM
I agree with everything Dr. Markinson said. The majority of hospitals are dropping the board requirement altogether. Where I practice, most of the internists, orthopods, and half of the OB/GYNs are not board certified. Nurse practitioners treat everything we can't. They actually have an online doctorate for them now so their patients can call them "doctor". Half the patients seen by all MD specialties, even rheumatologists and neurosurgeons are seen by physician assistants who have two years of actual medical training.
Every other medical entity is moving to increase access and scope of practice and we, as a profession, move in the opposite direction. Requiring a mandatory three-year residency will be the death of podiatry. Why would anybody attend medical school and a residency (analogous with an orthopod or a general surgeon) which severely limits scope of practice? Over the last 20 years, podiatry board certification has gotten more restrictive and exclusive, while at the same time board certification in general becomes more irrelevant.
When I told a friend I was taking the board recertification exam he asked, "What can you do that uncertified docs can't?" I was kind of taken aback that I couldn't answer him. I'm glad I took it. I can pat myself on the back and that's enough for me. Three-year residents should be able to do the same.
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net
06/12/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips from the Masters (Ron Raducanu, DPM)
From: Bryan C. Markinson, DPM
I agree with almost everything Dr. Raducanu states. He correctly states, “Many larger metropolitan hospital systems and many of the larger insurance carriers REQUIRE ABPS certification to be accepted on their staff, and also to have the ability to participate on the insurance panels.” What he conveniently leaves out (as does everyone else who reminds us of the “real world”) is that this situation is entirely and completely podiatry-created and propagated.
The newly minted certified surgeon convinces the local hospital that the DPM working there competently for 30 years is unqualified because he does not share the same certification, or did not do a three year residency, or a two year residency, or any residency, or blah blah blah. Then in the name of “credentialing” states that this is what the “hospital wanted.” Fratricide. Plain and simple. Statements like “with today's residency experience, there is really no reason NOT to be ABPS-certified,” is just a little smattering of the smugness that is pervasive within our ranks, and denies our true history.
What about the vast majority of us who did not have “today’s residency experience.”? Some of us have opened hospitals and major academic medical centers to ensure that this experience is available but was non-existent when we graduated school. Is it not crazy that I can be the chief of podiatry at a major academic medical center but completely blocked from working in a small community hospital by someone I trained, based on the “real world?”
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
06/09/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (Bryan Markinson, DPM)
From: Robert Kornfeld, 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...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
06/08/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (Bryan C Markinson, DPM)
From: Ron Raducanu, DPM
I think what is overlooked in this discussion about medicine vs. surgery is the real life implications of these certifications in today's world. Many larger metropolitan hospital systems and many of the larger insurance carriers REQUIRE ABPS certification to be accepted on their staff, and also to have the ability to participate on the insurance panels.
I do agree that surgery is "glorified" and that any practitioner worth their salt is just as versed in the medical AND surgical management of the foot and ankle. I don't agree that it should be either one or the other, though.
The reality is that with today's residency experience, there is really no reason NOT to be ABPS-certified. Unfortunately, for better or worse, this is the way of the world, and what I would like to see is a unified board of Podiatric Medicine AND Surgery (ABPMS?) and a unified College (ACPMS?). This would assure inclusion for EVERYONE (young and older, regardless of past and current training levels) and eliminate the "beating each other up" issues that are so prevalent.
Ron Raducanu, DPM, Philadelphia, PA, kidsfeet@gmail.com
06/07/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (Eric J Roberts, DPM)
From: Bryan C. Markinson, DPM
Dr. Roberts proclaims, “The reason I entered into the profession was so that I could be all-encompassing in medicine AND surgery.” Wow! He adjusts his proclamation by saying that anything he can’t handle, he will send to the appropriate clinician. Okay. But the striking thing about his proclamation is that he feels exactly like the podiatric colleges want students to feel when they “enter” into the profession. By the third year, it becomes clear that medicine is trivialized, and trips to Russia to learn Illizarov techniques are glorified.
We simply need to drop the “all encompassing” mentality and stop beating each other up. The American Board of Podiatric Medicine will be the first step, as hopefully those of us who love podiatric medicine will not be second fiddle to the surgical arm of the profession, which is wholly and absolutely and undeniably a situation we created for ourselves. Only when the ABPM certification is also a “certification you can trust,” will we be truly colleagues within our own profession, as the MD and DO communities enjoy. I should live so long.
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
06/06/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (John Fusco, DPM)
From: Eric J. Roberts, DPM
I respectfully disagree with just about everything stated by Dr. John Fusco in his analysis of our post-graduate education and specialization. The reason I entered into the profession was so that I could be all encompassing in medicine AND surgery. The inference was made that we are not smart enough to handle the entirety of our own field. While that may be the case for some (most?), I feel that I am intelligent enough to handle it. I shouldn’t be limited because of others’ shortcomings. If I can’t handle a particular problem, I’ll refer it to the appropriate specialist, even if that specialist is another DPM.
Eric J. Roberts, DPM, Forest Hills, NY, lordertz@gmail.com
06/05/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (Allen Jacobs, DPM)
From: John Fusco, DPM
Perhaps, as we realize the enormity of our profession's potential involvement in the many subdisciplines of both podiatric medicine and podiatric surgery, we need to to evolve a post-graduate/academic infrastructure similar to dentistry or allopathy/osteopathy, i.e. first, a professional degree (DPM), followed by either a residency in podiatric medicine or a residency in podiatric surgery. This would more efficiently utilize professional resources: If patients need care with (what is surely a multitude of) problems that are mainly, for want of a better term, 'non-surgical', then they should see a podiatric medical specialist. Likewise, patients who need surgical evaluation should see a podiatric surgeon. Just like in allopathic/psteopathic medicine or in dentistry, a patient sees an internist or sees a surgeon. He/she sees a general dentist or an oral surgeon.
The length/extent of post-graduate training in each branch (Pod. Med. vs. Pod. Surg.) should be defined, independently of the other branch, to reflect the realities of real-life practice; possibly, one branch may require more elaborate training or even subspecialty fellowships (e.g. surgical: external-fixation, traumatology, skin & soft-tissue, etc.; and, e.g. medical: dermatology, vascular, diabetology, neurology, etc.)
In any event, most podiatric practices should not be all-encompassing. As the study of human medicine continues to grow at such a fast pace, each of us trying to do everything (not to mention understand everything) herself/himself is not in the best interest of the patient.
John Fusco, DPM, Bellefonte PA, JOHNFUSCODPM@aol.com
06/02/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (Bryan Markinson, DPM)
From: Allen Jacobs, 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...
Editor's note: Dr. Jacob's extended length letter can be read here.
06/01/2012
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Success Tips From the Masters (Ron Soave, DPM)
From: Bryan C. Markinson, DPM
My dear friend Dr. Soave accuses me of an injustice regarding Vision 2015 by my stating that the profession has chosen to imitate orthopedic foot and ankle surgeons. Unfortunately, he interpreted and restated my remark as "imitating foot and ankle surgeons."
This, of course, is NOT what I meant at all. I am well aware that podiatric surgeons are indeed prominent in the art of foot and ankle surgery. I applaud and encourage all who so desire to become the best foot and ankle surgeons they can become. But my original comments were based on the indisputable fact that our schools lure in students by telling them that...
Editor's note: Dr. Markinson's extended-length letter can be read here.
06/25/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Podiatric Curriculums (Leonard A. Levy, DPM, MPH)
From: Ivar E. Roth DPM,MPH
Wow! Leonard Levy is right on. I never really gave this area much thought, but after reading his comments it made me think he is right. It is time to catch up and lead in this area.
Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net
06/24/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Podiatric Curriculums (Kirk Geter, DPM)
From: Leonard A. Levy, DPM, MPH
Having a broad experience with several podiatric medical schools as a dean of three and president of one as well as having similar experiences for more than fifteen years in allopathic and osteopathic medical schools, I have a different perspective of what the podiatric medical curriculum should be. First of all, indeed we are physicians. While we specialize in podiatric medicine and surgery, it is essential that our graduates share a common core with all physicians.
There are basic medical science experiences and certain core basic clinical rotations that MD, DO, and DPM students need to complete to achieve core competencies common to all physicians. However, I do feel that the way the so-called pre-clinical areas are being addressed in the podiatric medical curriculum, in many if not most of our schools, needs reassessment. The first two years of podiatric medical schools now includes extensive, didactically, and separately packaged courses in the basic sciences amounting to hundreds of hours of instruction in such areas as biochemistry, physiology, pathology, microbiology and the like. This no longer is the standard in medical education. It has been shown to be far more appropriate, let alone more interesting, to redistribute pre-clinical knowledge and concepts in a manner that integrates so-called basic sciences into clinical medicine, including podiatric medicine.
This is done in a number of ways in the MD and DO medical school communities, such as organizing major parts of the pre-clinical curriculum into all the organ systems of the body. This facilitates acquiring knowledge about the normal and abnormal structure and function of the human body, as well as prevention and therapeutics. A discussion of how the podiatric medical school curriculum should be organized is long overdue. Even national board examinations for medical licensure are organized in this manner. Podiatric medical students should not be excused from any of these systems since there are pedal manifestations of diseases and disorders intrinsic to every organ of the body.
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu
04/08/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Attracting New Podiatric Students (Bryan Markinson, DPM)
From: Michael Krischer, DPM
I have to agree with Dr. Markinson regarding non-parity and its effect on graduating podiatrists. When I graduated in 1999 in the top ten percent of my class, I did not match with a surgical residency. I swallowed my pride and made the most of my one year, non-surgical PPMR. I had favorable reviews and recommendations from my attending, but it was one of those "boom years." There were significantly more applicants than surgical spots available. The second year, I again did not match. Again, I swallowed my pride and made the most of it. It meant working harder as a lot of doors were closed to me. It meant struggling.
If you look at the ads for associates and group practices, almost all of them request PSR 24 or above training. Most private insurance carriers expect/demand surgical training. This is not sour grapes on my part; I love being a podiatrist and I was very fortunate to obtain a great non-surgical position. However, Dr. Markinson is absolutely correct that some students will spend eight years and over two hundred thousand dollars to obtain a degree and a deck stacked against them.
Michael Krischer, DPM, Cooper City, FL, mskrischer@cnhsa.com
04/06/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Attracting New Podiatric Students (Lloyd S. Smith, DPM)
From: Bryan C. Markinson, DPM
I read Dr. Smith's post three times before deciding to comment. First, I respect the long history of Dr. Smith's service to our profession in a multitude of positions. I am sure that his reticence to be critical is born only out of love for our craft. However, he states...
Editor's Note: Dr. Markinson's extended-length letter can be read here.
04/05/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS) - PART 2
RE: Attracting New Podiatric Students (Peter Smith, DPM)
From: Bob Kornfeld, DPM
While I totally understand Dr. Smith's reticence to allow his children to become podiatrists (or any other physician specialty), I do not think that we are in a "bad" profession. I do believe that doctors, as a profession, adopted a victim mentality and fell prey to all kinds of insurance regulations that made the insurance companies "the doctors" and us the technicians.
I do not know how any doctor agrees to accept a payment that...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
04/05/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS) - PART 1
RE: Attracting New Podiatric Students ( Bryan C. Markinson , DPM)
From: Lloyd S. Smith, DPM
I respect Dr. Markinson for his expertise in issues related to science, but his opinion on the post-graduate training of DPMs is an opinion deserving of critique. The availability of DPM residencies is dependent on the cumulative college admission class. If 600 DPMs graduate each year, we need 600 residency slots. But, what happens during lean times when we have 500 one year and then, boom times occur, and we have 700 the next? Having trained residents for over 30 years, there is simply no way our residencies can adapt. Programs are lost during the lean years and need to be resurrected when things change. This is a supply and demand problem that may be easy to critique but impossible to solve.
I had a prospective podiatry student shadow me today. Do we want to denigrate our profession, or face the reality of shifting supply and demand? Our profession will forever need to adapt. A positive attitude will allow our current students to become the leaders of the future. Let's support them by creating the residencies needed for them to succeed. Let's commit ourselves to providing every graduate a 3-year comprehensive residency program. Let's not get lost in a temporary residency program shortage in order to denigrate our future.
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com
04/03/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Attracting New Podiatric Students (Michael Trepal, DPM)
From: Bryan C. Markinson, DPM, Paul Liswood, DPM
Dr. Rosenblatt paints a rosy picture of how podiatrists thrive in poor economic times. He also encourages us to allow prospective students to shadow us. I have loved my work since day one, and today, I love it more than ever. I have had many prospective students shadow my practice. In fact, I have had some pre-med students shadow me in a special program here at Mount Sinai to encourage people for careers in medicine and have had some switch into podiatry. I have believed in the ethic of this process as a way to attract better students. I am as proud a DPM as could possibly be.
However, at the beginning of this past month, I have decided that I cannot in good faith encourage anyone to consider a profession that does not provide a post-graduate training spot for all of its graduates, when at the same time, the profession now mandates three years of such training. Some 50 graduates will be asked to sit out a year, unless some provision has been made that I am unaware of.
This is tragic, and all resources of the profession should fix it fast before one more high school or college student is encouraged. The days of "we at the schools never promised anyone a residency spot" should be long over. The silence on this has been deafening!
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
When Senator Schumer states that doctors are investing in technology for the sole purpose of making a profit, we have to understand there may be some merit to what he is saying. We have seen many doctors try to increase the scope of their services. Primary care doctors are giving heel spur injections, physical therapists are debriding ulcers, and chiropractors are making orthotics. Why is this happening? This may be happening because doctors are looking to increase the scope of services they provide to compensate for inadequate reimbursement rates. At some point, that is the issue that needs to be addressed.
I am a third generation podiatrist, and I would love my children to become fourth generation podiatrists. Podiatry has been good to me so far. However, I was told that the average DPM makes about $130,000 a year. The cost of podiatry school is very high. The average residency program is now three years. If you want to recruit more DPM’s, you have to have the average DPM salary go up, and the cost of education go down. Simple economics.
Paul Liswood, DPM, Brooklyn, NY dr.liswood@verizon.net
04/02/2010
RESPONSES / COMMENTS (SUCCESS TIPS FROM THE MASTERS)
RE: Attracting New Podiatric Students (Michael Trepal, DPM)
From: Peter Smith, DPM
Life, sometimes, can be both entertaining and ironic. On Sunday, I saw my own NY Senator, Chuck Schumer, tell Dick Gregory on Meet the Press that one of the real big problems in medicine was the fraud, abuse, and redundancy that doctors commit. He went on to say that there are some doctors that actually buy new technology equipment, then use that equipment FOR PROFIT! Imagine the outrage - a doctor actually trying to...
Editor's note: Dr. Smith's extended-length letter can be read here.