04/19/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions
From: Joe Agostinelli, DPM
Let's think out of the box on this. Is it time to consider a radical change in our podiatry world? Should we have a goal of letting the DPM degree sunset, having our students attend regular MD or DO medical school for four years, complete a one-year internship, where you learn to be a physician first, then complete a two-year residency in podiatric medicine/surgery with follow on specialty fellowships to develop a "regional foot and ankle specialist" MD or DO physician?
Please do not comment that we are already "physicians" according to some federal definition that has no practical...
Editor's note: Dr. Agostinelli's extended-length letter can be read here.
04/16/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions (Robert Kornfeld, DPM)
From: Robert Kornfeld, DPM
I would like to clarify my offer since many of the 104 wanted to know how to "apply" to the Pre-Residency Fellowship in Integrative Podiatric Medicine. This offering is open to all of "The 104." There is no application necessary, only the desire to become part of medicine’s fastest growing sub-specialty of integrative medicine and the desire to become part of the residency shortage solution on a team, in community with collaboration.
We are looking to create a population of podiatrists who will enter their professional practices with an expanded focus on foot and ankle medicine. The fellowship will include medical training, education, and research through the lens of integrative medicine. These DPMs can become a resource and consultant for traditionally trained DPMs who wish to add a new dimension to their practice. Stipend: with the support of the profession, we are anticipating that each Fellow will receive a stipend of $27,000 - $38,000.
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
04/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: MI Podiatrist Sentenced to Prison in Healthcare Fraud Scheme
From: Cynthia Cernak, DPM
In the past two years in Wisconsin, we've had two notable physicians make headlines with their crimes. One was involved in a cocaine selling scheme and even had a loaded shotgun in the backseat of his car. He was caught with the goods. A second physician in his group is also implicated in the cocaine business. They have never seen the inside of a jail cell and are cutting deals to get off with community service.
The other physician is a well-known neurosurgeon who is being accused of millions of dollars of offshore accounts with Medicare payments. He also is getting off with community service and now opening a new office in the Racine area. It seems as though it was the attorney expertise that these two physicians were able to afford to buy that enabled them to get off so easily.
Cynthia Cernak, DPM, Kenosha, WI, dr.cernak@gmail.com
04/11/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: MI Podiatrist Sentenced to Prison for Healthcare Fraud
From: Martin V. Sloan MS, DPM
It saddens me to read of the travails of Dr. Kirk, or of any colleague. But it also concerns me that seemingly others are suggesting the legitimacy of submitting CPT code #11730 for the debridement of toenails. By definition, 11730 is "the avulsion of a nail involving separation and removal of the entire nail plate or a portion of the nail plate (including the entire length of the nail border to and under the eponychium)." A television commercial from years ago that will always stick in my mind ended with the line "it's not nice to fool Mother Nature." I think it behooves all of us to be as informed as we can be in this ever-changing world.
Martin V. Sloan MS, DPM, Abilene, TX, doc@drmartinsloan.com
04/09/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: MI Podiatrist Sentenced to Prison for Healthcare Fraud
From: Michael M. Rosenblatt, DPM
I offer my condolences to yet another podiatrist caught in the 11730, 11732 minefield. This is the code that puts most podiatrists in jail, beyond phantom patient billing. This all stems from the fact that nursing home/office nail care is not paid by insurers or Medicaid, except under very specific conditions we are all aware of (or should be). In order to perform this legally, it must be a covered RFC service, with all of the attendant clinical factors as part of the service. Or, alternatively, a local anesthetic must be injected. I have written this before, but yet I still read about it.
If you see nursing home patients, you must search for other codes to use, and often there are OTHERS that are appropriate. But you must actually examine your patients, their history and physical, and their legs and ankles. About 30 to 65% of NH patient care is given free. Only you can decide if that fits your practice model.
Auditors first look for 11730. There are ways to document this service (including photographs of your injection with a chalk board and the patient’s name and date). Unless you are able and willing to use this standard of documentation, my advice is to eschew NHs entirely. The next time your patient asks: “How come Dr. Downtheblock does this for free?”, do yourself and your family a favor and send them there.
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
04/05/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions
From: Barry Finkelstein, DPM
I would like to add my thoughts to lend encouragement to the students who did not match for residency positions.
I found myself in a similar situation in 1997 when my residency ended abruptly after one year without proceeding to the surgical year(s). I ended up joining the work force and then returning to a 3-year surgical residency several years later. It was the best professional move I have made. To be sure, the financial strain was enormous; however, ...
Editor's note: Dr. Finkelstein's extended-length letter can be read here.
04/04/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions
From: Simon Young, DPM
As a former residency director of a PSR-24 program in NYC, I know how difficult it was to achieve the required numbers of cases for graduation. I knew that the program would truly struggle to fulfill the necessary cases for one PSR-36, much less 3 or 4. I voiced my concerns to the CPME and was quite adamantly ignored.
APMA and CPME should've projected and anticipated the multitude of hospital closings. The extra cases required for every graduate to fulfill PSR-36 case requirements present a daunting situation. My stance on post-graduate quality of education is well documented. Emphasis continues to be on money and jobs for the people involved in student and residency training. Let it be so, but quality must never ever be compromised and, believe you me, it is compromised. APMA and CPME in their wisdom opened more schools to graduate more students in anticipation of a shortage which never transpired, a ludicrous situation. A slight shortage is good for the viability of the profession. We can always fill a shortage of practitioners quickly.
Podiatry schools are being merged with medical schools. This is a formula for failure. The medical schools can dissolve the charter of the podiatry colleges and close the affiliated podiatry schools. We need fewer students graduating, but with a higher quality education, professionalism, courtesy, and respect. Class sizes must be adjusted to anticipated residency slots of the incoming classes on a regular basis.
Simon Young, DPM, NY, NY, simonyoung@juno.com
04/03/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions
From: Robert Bijak, DPM, Leslie Levine, DPM
Numerous opinions have been proffered to solve podiatry's educational problem except the correct one. The correct solution is to realize that the foot and/or ankle is too narrow of an anatomical/disease entity to necessitate the present number of graduates and residents.
The answer is to change the DPM to a full scope specialty emphasizing lower extremity and gait uniquely, as osteopathy is full scope with its unique philosophy of musculoskeletal-nervous system etiology. This will immediately make the graduates useful to hospitals and patients who...
Editor's note: Dr. Bijak's extended-length letter can be read here,
Call me cynical, but here is my take on the 104 unmatched students. It's all about playing in the insurance company reimbursement sandbox.
First, we need a little history. Back in late '60s or so, a group of podiatric surgeons from the American College of Foot Surgeons grandfathered themselves in as Fellows, and in doing so, convinced insurance companies that...
Editor's note: Dr. Levine's extended-length letter can be read here.
04/01/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions (Bryan Markinson, DPM)
From: Vincent Gramuglia, DPM, Alan Sherman, DPM
As always, Dr. Markinson has broken down a complex issue into a fine powder. Simply put, we are a group of "podiatrists" not podiatric surgeons, podiatric orthopedists, diabetic wound care specialists, etc.
Our collective need to assimilate to everything other than podiatry has led us to the current residency model requiring advanced levels of surgical competency from podiatrists, 60% of whom will either never perform the surgeries they were ostensibly trained to do, or who will be in over their heads when they attempt these procedures because the numbers have been so diluted to accommodate more residency positions. What is the answer? I don't know, but when a difficult problem presents itself, its always a good idea to look in the mirror and when I do, I see a podiatrist.
Vincent Gramuglia, DPM, Bronx, NY, a2onpar3@optonline.net
It is remarkable how often I agree with Dr. Markinson – and his last comment on this topic is no exception. Going back to a preceptorship model is just wrong. We do need a lot more podiatrists, but we don’t need to train more advanced podiatric surgeons. There is a catch-22 situation in podiatric training that isn’t discussed much (I’m not sure why), but it is the “elephant in the room” during every discussion on podiatric post-graduate education. It goes like this:
In order to get on insurance panels, you must be on a hospital staff. In order to be on a hospital staff, you must be...
Editor's note: Dr. Sherman's extended-length letter can be read here.
03/29/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions (Lawrence Oloff, DPM)
From: James J DiResta, DPM, MPH, Jeffrey Kass, DPM
I rarely miss a morning read of PM News. In fact, I often compare myself sitting at my laptop reading PM News to my dad, who years back each morning would survey the morning paper drinking his coffee before leaving for work. I could often sense his emotions as he looked at the national headlines, box scores, and of course the results of horse races from the nearby track.
I wonder now what those around me are thinking when I read entry after entry about this enormous shortfall that our profession has left with these unmatched...
Editor's note: Dr. DiResta's extended-length letter can be read here.
There is nothing wrong with one-year or two-year podiatric residencies. Some of podiatry's greatest minds and surgeons had no residency training at all. It should not be "all or nothing." Not everyone in podiatry wants to do a three-year program, not everyone wants to do rearfoot reconstructions, etc. There are numerous practices that thrive without it.
The great thing about podiatry is its diversity. By forcing everyone to perform 3-year residencies when they are not necessary. Does a podiatrist who wants to have a biomechanical practice need a 3-year program? Does a podiatrist who wants to practice "podiatric medicine" need a three year program?
I am not sure 100% of how the dentistry world works, but I know there are some dentists who have a DDS and others who carry DMD titles. Maybe, that is the direction we need to go. Do your 3-year program and come out with a PMD (podiatric medical doctor) vs. a DPM. Using NY as an example, the law allows one to practice with a one-year residency. The problem is that a one-year program no longer exists. I understand the "powers to be" have decided this is the best course for podiatry to take...but is it? With the current residency crisis, I am not convinced.
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com
03/25/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions (Ivar Roth, DPM)
From: Paul J Maglione DPM, Trevor Neal, DPM
It is different when someone fails and is unable to obtain licensure. A preceptorship is appropriate, but not when someone, through no fault of their own, is denied their podiatry license. Luckily, my son graduated from medical school, not podiatric medical school, or I would be seeking legal counsel.
Paul J Maglione, DPM, Ossining, NY, drmaglione@aol.com
I agree that preceptorships could be the answer, but here’s the problem. Most states do not allow preceptorship for licensure. They were removed when there were enough residencies for every graduate. And even though it was still “on the books” in Michigan, I had to go before the State of Michigan Board of Podiatric Medicine to get a preceptorship approved.
After fighting to get a preceptorship approved and having my preceptee complete a 2-year preceptorship, she was able to get a full license to practice, but unable to participate with many of the Blue Cross policies because...
Editor's note: Dr. Neal's extended-length letter can be read here.
03/16/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: PA Podiatrist Among Highest Paid by Big Pharma
From: Elliot Udell, DPM
In an ideal world, Dr. Joseph would be able to fly every weekend and midweek to another city and lecture on infections of the lower extremity without getting paid. We don't live in a fantasy world. Speakers have to eat, drink, and support their families. Hence, if we want highly specialized speakers to devote their lives to teaching and coaching, they need to get paid.
Many conferences can afford to subsidize a speaker's expenses and give him or her an honorarium. That is the best scenario, however not every hospital, or small conference can afford to do this for every speaker, hence the medical profession has become dependant upon corporations to bankroll many of their invited lecturers. Dr. Joseph deserves special praise. His lectures, while subsidized by companies that manufacture antibiotics, are unbiased. Many of his presentations are totally devoted to fielding clinical questions from participants and have nothing to do with the companies that subsidize him.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
03/15/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: PA Podiatrist Among Highest Paid by Big Pharma
From: Eric M. Hart, DPM
I don't see any shame in the report that Dr. Warren Joseph is one of the highest paid consultants/speakers to the pharmaceutical industry. I have heard Dr. Joseph speak on several occasions and have found him to be an unbiased expert who promotes limb salvage and good antibiotic stewardship--both of these are more worthy of a nice salary in my opinion than most of the over-paid positions held by insurance company executives.
Eric M. Hart, DPM, Bismarck, ND, erichartdpm@gmail.com
02/11/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: CA Podiatrist Discusses Treatment of Plantar Tears
From: Amol Saxena, DPM
In 2004, Brian Fullem and I published a paper on plantar fascia tears in the orthopedic journal, American Journal of Sports Medicine (which has the highest impact factor in orthopedic journals): ncbi.nlm.nih.gov/pubmed/15090382. The average return to activity was 9 weeks, with no athletes (including professionals) requiring surgery when following our treatment regimen. This is an often referenced article in the orthopedic community.
I highly recommend that all "foot and ankle specialists" read this. Anecdotally, I know of one professional baseball player who tore his plantar fascia and had it repaired acutely. He eventually had it released. Incidentally, prior to that, his other foot also had a release for plantar fasciitis .
There is a recent chapter "Plantar Fascia Injuries" we just published in Foot and Ankle in Sports Medicine edited by David W. Altchek, M.D, Jonathan T. Deland, M.D., Rock Positano, DPM, MSc, MPH, and Joshua Dines, M.D.,(Lippincott, 2012) that highlights the current evidence-based treatments, including indications for surgery. Acute plantar fascial injuries are not one of them.
Amol Saxena, DPM, Palo Alto, CA, Heysax@aol.com
01/08/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: NY Podiatrist Advises Against Cosmetic Foot Surgery (William Deutsch, DPM)
From: Gino Scartozzi, DPM
With this ongoing conversation of "cosmetic" foot surgery, I read Dr. Deutsch's post and final quote "why should a surgically-trained podiatrist be less of a physician than a surgically-trained cosmetic surgeon?"
I was in my office the other day treating a 15 year old male who presented with his nanny. The boy presented with a paronychia of the left hallux nail which has recurred since last seen approximately six months ago. The mother of the patient was unable to...
Editor's note: Dr. Scartozzi's extended-length letter can be read here.
01/01/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: Rising Patient Deductibles Spell Trouble for Doctors (Allen Jacobs, DPM)
From: Richard A. Simmons, DPM
Dr. Udell expressed concern that his next colonoscopy will cost him thousands of dollars and that this might deter him from having this performed. Under the Affordable Care Act is the provision called Providing Free Preventive Care: All plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay, or co-insurance. What one has to remember is that screening is free; however, if a procedure is performed with the screening, then there can be a charge to the annual deductible, co-pay, or co-insurance. For more information and a complete list of preventive services covered under the Affordable Care Act, click here:
Richard A. Simmons, DPM Rockledge, FL RASDPM32955@gmail.com
11/22/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: NJ Podiatrist Warns of Universal Life Insurance Danger
From: Joel Lang, DPM
As a financial planner, I do not know all the details of this particular situation, but this scenario occurs way too often in my practice. This article points up the truth that real financial planners know - no one (with rare exception) should ever buy anything other than term life insurance. Insurance salespeople (who often masquerade as financial planners) make large commissions on the sale of these fancy policies and often mislead the client about the rewards projected down the line. Meanwhile, the reward for the salesperson are immediate!
To add insult to injury, it seems that the client was advised to purchase more life insurance with the proceeds of prior policies. Why would a 66 years old need more life insurance? As people grow older their need for life insurance decreases, not increases. It appears what they need is cash flow to cover their current expenses. This insurance salesperson was only looking out for him-/herself, obligating this couple to a never-ending course of increasing premium payments.
Term life insurance fits the needs of 99.9% of everyone when properly structured and is very inexpensive and never increases in cost. The artificial mix of life insurance with savings, investments, and annuities only makes the product unnecessarily expensive, and rarely does it deliver on what is promised.
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net
11/10/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: OH Podiatrist Elected To U.S. Congress (Wenjay Sung, DPM)
From: Avi Kornbluth
I disagree - Doctor means you put in time, gathered knowledge, know-how, and are ready to help everyone that you can. Congressman means you got elected and now can take a 2 year vacation! (until re-election) - no credits needed, no courses to advance your knowledge.
I am a third generation serving the podiatry community - yes, there are a few "rotten apples" but for the most part, you "guys & gals" are an elite group - so I say congratulations to Dr. Wenstrup.
11/02/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: NJ Podiatrist Arrested for Allegedly Groping Patient's Breasts (Michael Forman, DPM)
From: Pete Harvey, DPM
As a former reviewer of thousands of med-mal claims, I can assure you that sexual allegations are common and usually true. I go to several doctors such as a dermatologist, GP, dentist, etc. and I can’t think of a single one who doesn’t have a second staff member in the room at all times. Consider it insurance.
10/06/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: CA Podiatrist Discusses Limb-Lengthening (George R. Vito DPM, MBA)
From: Bryan C. Markinson, DPM
I fully support free choice for people to chose elective cosmetic procedures, but do NOT support any surgeon whether plastic, cosmetic, podiatric, etc. in providing the service simply for the asking. In my opinion, the use of limb-lengthening procedures promoted by podiatric surgeons to increase height wipes away in one stroke all advances that have been made in the correction of serious deformity resulting from trauma, limb salvage, congenital anomalies, etc. Podiatrists should not jump on the "let me make you taller" bandwagon.
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
10/01/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: International Podiatrists in the News
From: Barry Francis
I read Dr Bijak's letter with a little dismay as I do not think that it reflects an accurate picture of podiatry internationally. In the UK, students do complete a bachelors degree as described. Those wishing to complete training in surgery then have to complete a masters before proceeding to surgical training (the equivalent of board certification). This latter training can take up to 4 years.
This route is intended to produce individuals who can aspire to consultants posts within our state service. These surgeons will usually also have private practice arrangements. I believe that our surgical practice is on a par with that performed in the U.S. generally speaking, although this sector of the profession is certainly smaller than that in the U.S.
There is a similar emerging training in Australia. Training in mainland Europe varies as does practice but practitioners are often described as podologists there. One thing is very clear: the UK owes a debt of gratitude to those U.S. podiatrists with vision and generosity who aspired and assisted us in the early years.
Mr. Barry Francis, Consultant Podiatric Surgeon, barry-francis@hotmail.com
09/17/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: Congressman Disparages the Podiatric Profession and CA Podiatrist's Campaign
From: Greg Aposperis, DPM
The ad for Congressman Buck McKeon implies that because Dr. Lee Rogers is a podiatrist, he lacks the qualification for being a congressman. This is a prime example of politicians living in glass houses. According to "Project Vote Smart", the Congressman is owner of "Howard and Phil's Western Wear." I am not certain, but I do not think this occupation trumps being a podiatric physician and surgeon. Both are small businessmen; both carry inventories; both have business expenses, including employees; and both pay taxes and insurance.
One makes people feel good by looking like a cowboy; the other makes them feel good by treating their diseases. Congressman McKeon learned to "be a representative" by being elected and then learning the ropes. I am sure that Dr. Rogers can do the same. Someone once wrote that there are two types of achievers in this world: one who raises the bar by good works and deeds; the other appears to raise the bar by denigrating those around him.
Greg Aposperis, DPM, Santa Barbara, CA, santabarbarafootclinic@yahoo.com
06/30/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: NY Assembly Passes Expansion of Scope of Practice Law (Bryan C. Markinson, DPM)
From: Mark J. Tuccio, DPM
The devil is always in the details and this is, without a doubt, a perfect example of that statement. That said, what exactly does the scope of practice law in NYS have to say about podiatrists treating lower extremity leg ulcers? I am interested to hear from those in the state level who know the statute forwards and backwards.
Mark J. Tuccio, DPM, Jamestown, NY, mtuccio1@stny.rr.com
06/29/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: NY Assembly Passes Expansion of Scope of Practice Law
From: Robert Bijak, DPM
Perhaps I don't understand the nuances of this law. In one respect, I see that ABPS certification is required to touch the ankle in NY. Then I read "rear foot" ABPS certification is needed. We are tiering the poor little foot into fiefdoms, and a "foot specialist" is now only a specialist of part of the foot in NY. It seems we have restricted our scope, not expanded it.
I think that those who are ABPS-certified are now feeling the exclusion that the non-certified DPM feels, if they aren't REARFOOT CERTIFIED. Do MDs parse up the foot like we do? I'm not sure I agree with the other posters who say this is such a great thing for NY podiatry, if you live in this temporal dimension! Hurray for the future or that very limited "rearfoot" DPM today. It truly leaves everyone else flat (footed). When I went to podiatry school, I thought I was going to be a foot specialist with no asterisks around it. I guess the NYSPMA tried to expand our scope, but the legislature is still hung up on that limited DPM degree.
Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com
06/28/2012
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: NY Assembly Passes Expansion of Scope of Practice Law (Jeffrey Kass, DPM)
From: Paul Kesselman, DPM
I tend to agree with Dr. Kass, that on first look, the recently passed scope of practice bill potentially creates a two-tier licensing structure for podiatrists in NYS. At first look, it may be seen as unfair to the vast majority of DPM's who never had an opportunity to obtain board certification, or to be trained in a two or three year residency.
It also may seem unfair to many who have achieved surgical board certification after a one-year residency or alternative method. Many of the latter categories are actually the majority of us who teach and are attending podiatrists in two- and three-year residency programs (myself included). This thought process, however, is very short-sighted.
Without some tangible change in the scope of practice, ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
