Podiatry Management Online


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RE: Podiatric Residency Crisis - Where Are We?

From: Bret Ribotsky, DPM

On April 23, APMA’s executive director and three deans from our podiatric schools appeared on a special Meet the Masters show. These brave doctors stood strong to many questions regarding this crisis that affects over 90 lives and possibly the future of our profession. Drs. Gastwirth, Jensen, Mattiacci, and Harkless were open and very concerned with what occurred and optimistic about a solution. It was mentioned that the Council of Podiatric Medical Education (CPME) was meeting and it was Dr. Gastwirth’s hope that many obstacles to fixing this crisis would be worked out within a week or two after the CPME meeting. So far, nothing was changed, the problem remains. 

I have offered CPME multiple opportunities to appear on Meet the Masters to explain WHY changes have not occurred; these requests have been declined. It’s June and these students have graduated, but the problem remains. WHAT IS BEING DONE? Have these graduated students been forgotten already? How many are still without programs?

Bret Ribotsky, DPM, Boca Raton, FL,

Other messages in this thread:



From: Larry Kobak, DPM, JD


This email is in response to Dr. Udell's inquiry if you can sue a patient or social media site that posts an untrue review. The answer is sometimes. If the review merely expresses an opinion, that is protected constitutionally. In NY, if the patient goes further and states something that reflects on the podiatrist's ability, such as "(s)he is a butcher", or inaccurately, such as (s)he lost his/her license last year, that is actionable. I have successfully sued the patient for libel in such cases. Please be warned that there is a statute of limitations in such cases. In NY, it is only one year from the time the review was first published.


Larry Kobak, DPM, JD, Senior Counsel, Frier Levitt



From: Kenneth T. Goldstein, DPM


I totally agree with Dr. Udell. Years ago, when a patient didn't want to pay a bill, they threatened to sue. Now-a-days they threaten to post a "nasty review"(because it will cost them money to hire an attorney). The fact that this patient not only wanted the fees removed, but also a DISCOUNT! is absolutely ridiculous. Should you give in, this person sounds like they will write the negative review anyway and say to themselves - "Gotcha".


You have done all of the correct manners and given more than enough time for this patient to pay. At this point my answer would be - It is out of my hands and the collection company has control of your account.


Kenneth T. Goldstein, DPM, Williamsville, NY



From: Jarrod Shapiro, DPM


I'm writing in response to Dr. Sherman's comments about online CME. I agree with his comments and support the opinion that online CME should be unlimited in all states. Simply put, the content and delivery is the same, the requirements for proof of viewing is higher than at live conferences, and this delivery method is appropriate for adult learners. The various online CME available allows a physicians to receive rapid answers to topical clinical problems using on-demand education services. This format is innovative and able to change with developing technologies. Allowing online CME to flourish is equivalent in the medical community to the progress of the Internet itself. This system must be allowed to develop.


Disclaimer: Dr. Shapiro writes the column Practice Perfect for PRESENT e-Learning Systems.


Jarrod Shapiro, DPM, Pomona, CA



From: Lee C. Rogers, DPM, Ed Davis, DPM


The Internet has made education available to everyone with a connection, without unnecessary time and travel expense. I encourage our state boards of podiatry to modernize their CME requirements to take advantage of these advancements in technology and the renaissance that will be the future of learning.


Lee C. Rogers, DPM, Los Angeles, CA


Dr. Sherman is right concerning the issue of certain states restricting online CME. One can go to a "brick and mortar" CME seminar but no one can ensure that attention to the subject matter presented occurs nor that the attendee is even awake. Online CME generally requires that attendees read the material presented and answer questions to ensure learning.


Ed Davis, DPM, San Antonio, TX



RE: Why Do Some State Boards of Podiatry Still Limit Online CME? (Alan Sherman, DPM)

From: Larry Aronberg, DPM

I completely agree with Dr. Sherman. When I go to a bottoms-in-the-chairs seminar, people wander in and out, tune out the lecture, etc. You just have to sign in and sign out for credit. With online, there is a test you have to pass. You have to learn the material to get the credits. When you also consider travel, lodging, and time away from your practice when attending a seminar, online seems even more logical. I love the hands-on courses at seminars, but would much prefer most of my credits online with just an occasional trip for a distant seminar.


Larry Aronberg, DPM, Lake Worth, FL



From: Barbara Hirsch, DPM


In 2015, the Maryland Board of Podiatric Medical Examiners initiated a change in the state regulations to go from 50 CME allowed online to only 25 online CMEs allowed online. I am the only Maryland state licensed podiatrist who commented against this proposed change to the state (during the allowed comment period). I felt it was ridiculous to decrease the amount of online CME allowed for various and obvious reasons, the main one being cost. Even a "local" seminar can require travel costs, lodging costs, and high fees.


I provided examples of what it costs to attend many seminars. I provided an example of the exact same seminar offered online (a taping of the seminar) and live. The only difference was the cost. The state of Maryland has limited CME seminars, and one cannot always attend due to personal reasons.  


The MPMA used to have a "Day of Science" but this has not been done in a few years (it was used as an example of "Free" CME credits for a live seminar as one "excuse" for the change in the requirements. I was not only thinking of myself, I was thinking of anyone else who has monetary issues/concerns, physical issues, family issues, etc. I only wish that other Maryland state licensees had similar concerns for their colleagues. Allowing 50 CME online credits let everyone do what was best for them. Limiting online CME credits to only 25 was a step backwards. 


Barbara Hirsch, DPM, Rockville, MD



From: Bret Ribotsky, DPM


I’ll take the counterpoint to my friend and Boca Raton neighbor, Dr. Sherman. Live CME events are best. Not only have I had the opportunity to have lectured in 49 of the 50 states and many 15 different countries, but I have also been the patient for multiple foot operations. For the months after my accident, I spent many months in rehab, unable to walk, and did many online classes. I collected online training certifications in real-estate, insurance, financial planning, securities series 7, 63, and a bunch more. But... there is nothing as good as live learning. And as a physician, there is so much more to learn at a seminar than what is learned in the lecture hall. I have learned so much in the hallways, and at the bar from my colleagues. Meet the Masters was started 8 years before my injuries, with the idea that learning outside of the lecture hall was priceless.  


I do enjoy online events, but I would hate to miss the yearly get togethers to learn from and with others. As a patient, I know the difference between great and outstanding care; that it comes from those with exposure to many viewpoints which only a live event can deliver.  


Bret M. Ribotsky, DPM, Boca Raton, FL



RE: Why Do Some State Boards of Podiatry Still Limit Online CME?

From: Alan Sherman, DPM


It’s about time that someone spoke out publically about the restrictive policy in a few last remaining states regarding online CME for podiatrists. 60% of State Boards of Podiatry, 30 out of 50, now allow ALL CME Credit to be earned online. This evening, one of my oldest and dearest friends from CCPM reminded me that our home state of Florida still only allows 8 of their 40 required credits every two years to be earned online. That’s 20%. Come on, Florida. 


Why is it important to this guy? Because this year, he has had pneumonia and a GI bleed, and with all the time he has missed from his practice, he can’t afford to attend another...


Editor's note: Dr. Sherman's extended-length letter can be read here.



RE: Fire Disaster Relief in Sonoma County, CA and Adjacent Areas

From: Jesus C. Vazquez, PMAC 


Sonoma County is very grateful for the support from first responders during the fire disaster affecting our community. Dr. John D. Hollander is going to be providing foot and ankle care at no cost to police, firefighters, utility responders, and paramedics helping our community through this crisis. The office will be providing walk-in and evening appointments to accommodate different working shifts of first responders. 


Jesus C. Vazquez, PMAC, Santa Rosa, CA



From: Dennis Shavelson, DPM


I am a 71 year old practitioner and find myself more and more successful attracting millennial patients by marketing how I practice.

  •  I offer holistic cures, not just tunnel vision Band-Aid care.

  •  I offer care of treatable underpinning pathology (medical, biomechanical and   kinesiological).

  •  I practice Prevention, Performance Enhancement and Quality of Life Upgrading.

  •  I offer more seamless office visits and availability in the cloud.

  •  Rather than state that I treat everything for every foot, I market niche compartments of diagnosis and care (biomedical engineering and ugly toenail cures).

  •  I have hardship and sliding scale fees available.  

Dennis Shavelson, DPM, NY, NY



From: Bryan C. Markinson, DPM


My friend Dr. Robert Hatcher is absolutely dead on about "working smarter, not harder." There is no question that we should all strive for life balance and more efficiency in our practices. But "working smarter, not harder" is predominantly an empty sentiment....but only us old timers get it. I teach students, residents, and young colleagues on a regular basis. One of my most common points is "the days of 9-5 are long gone." If you want to coach little league and catch every ballet recital, and go to "mommy and me", you may need to settle for a three bedroom house instead of a 5 bedroom house. If you don't get what I am saying, advice on office efficiency and life balance is wasted on you.


Bryan C. Markinson, DPM, NY, NY



RE: Millennial Expectations

From: James E. Koon, DPM


For some time now, patients have been researching their doctors on the Internet. I am consistently told by new patients that they chose me based on my Internet reviews. Word of mouth referrals are still a mainstay of my practice. I have never advertised. 


My experience has been that all patients’ expectations are rising. Everyone wants everything given to them and they all want their insurance to pay for it. Many come in with pre-conceived ideas of what they have because “Dr. Internet” has seeded their minds. Many come in wanting...


Editor's note: Dr. Koon's extended-length letter can be read here. 



RE: Excessive NBPME Exam and Reporting Fees

From: Nicholas A. Ciotola, DPM


Why does NBPME/APMLE charge so much money? Because they can.


Nicholas A. Ciotola, DPM, Methuen, MA



RE: Time Wasted

From: Larry Schuster, DPM


An insurance company just requested we fill out and attest to demographic information on our practice. We have done this many times for many insurance companies. We usually look at a page of pre-filled info, and if no changes, click approve. It takes 5 minutes maximum. If you need passwords, etc. to get on the site, it takes a little longer. .


We are seeing more complex forms every day to the point of craziness. Today, I received a request to fill out such a form with the recommendation that I attend a 30-minute webinar on how to fill out the form. I will have to do this after finding my sign-on credentials.


Larry Schuster, DPM, Parsippany, NJ 



From: Arnold B. Wolf, DPM


In response to Dr. Freireich's recent post, I am compelled to respond to all issues pertaining to the MACRA/MIPS conundrum that we are facing. MACRA/MIPS is "supposedly" all about creating an environment of cost-effective and efficient delivery of healthcare services. Of course, this is being constructed by our federal government...a highly inefficient, wasteful organization. We, once again are the victims of their ineptitude. I liken their skillset to an orchestra conductor who can't read sheet music...and we're forced to play on. MACRA/MIPS is like all the other poorly concocted schemes foist upon physicians under the guise of trying to make healthcare delivery more efficient.


I submit that the additional data collection and additional data mining is a waste of time. Issues of meaningful use, quality measures, MACRA/MIPS and the like are created for one reason reduce reimbursement. Collectively, medicine is the only "government contractor" (recipient of public tax dollars under Medicare, Medicaid, FEP...) that gets "incentivized" by not getting "penalized". By submitting the data bundled in our insurance billings, we are providing more than ample information as to our individual practice patterns and utilization. That, in fact, should be enough. After all, it really is all about how much less we can get paid, and not how well we do our jobs. It would be nice if all doctors could resume the practice of treating patients and not focus on treating their computers.


Arnold B. Wolf, DPM, Sterling Heights, MI



From: George Jacobson, DPM


Since this topic has come up again, I would like to remind everyone of a posting that I wrote on 03/05/2016. You can search it in the PM News archives. In a nutshell, here is the main excerpt, "We received a letter from Palmetto GBA stating that they have received information from the National Supplier Clearinghouse (NSC) indicating  that we have not billed the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) within the last four consecutive quarters."   


George Jacobson, DPM, Hollywood, FL 



From: Martin G. Miller, DPM


I went to the website that Dr. Kesselman referenced in his response, and after putting in my NPI, it correctly identified me and my specialty (podiatry), but it only said revalidation: TBD. I assume this means "To Be Determined". I guess I have to keep checking back to see if any date actually shows up. It would be far more helpful if the actual date was given.  


Martin G. Miller, DPM, Freeport, NY



From: P David Applegate, DPM


Congrats on making it to your third year! Before all, it's important to be aware of what kind of job you feel you'll fit best into. Podiatry has grown into a field with an array of practice options. This is something you'll have to answer and it will be based on your training and personal interests. Once you've gotten an idea what you're looking to do, it's never too early to start working towards finding a job. In fact, if you end up finding one in a state you weren't originally planning on going to, it's critical that you are aware of timelines on state licensing. In short - the earlier the better. Relevant job listings can be found in a number of places. A Google search will go a long way towards finding ones outside of PM News


There's also nothing wrong with taking an active approach and reaching out to every practice/hospital/etc. in a given geographic area that you're interested in and asking if they'd consider hiring you. The worst they can say is no, and many may know someone in town looking to hire someone. Other options include a year of advanced training in a fellowship, but make sure you're aware of the timelines and nuances of the application process. A list of ACFAS-recognized fellowships can be found here.  


P David Applegate, DPM, Katy, TX



RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)

From: David E Gurvis, DPM


I recently had a request for 50 charts to be reviewed. That was a very unusual request, but that is not my question. The insurance company said if I wanted to give them access to my online EMR, they could log in and review those charts in that fashion.  


While that sound convenient, more so than printing them all out, it just sounds risky as it relates to privacy concerns. Has anyone allowed an insurance reviewer into their EMR? Is that even legal?


David E Gurvis, DPM, Avon, IN



RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)

From:  Cynthia Ferrelli, DPM


I have experienced the same problem, so I came up with a solution several months ago that has been working fine. When my office is called for a chart review, we say we will comply but that their reps come to my office, will have to pull all the charts themselves, and find what they need in the chart. We tell them that this is how we do it and we set the guidelines. Set your boundaries. You are paying your staff to do work for you, not for the insurance companies. We seem to do enough of that already.


Cynthia Ferrelli, DPM, Buffalo, NY



RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)

From: Matthew B. Richins, DPM, Cynthia Ferrelli, DPM


When we get a request, my office manager charges a fee for our supplies and her time to the companies, to be paid in advance. Most pay. Others ask to send a representative out to make the copies. We tell them to bring their own paper, printer, and ink - and they do!


Matthew B. Richins, DPM, Joplin, MO



RE: Microscope for KOH Preps (David Kahan, DPM)

From: Carl Solomon, DPM


I've been doing KOH preps for a while and they're simple. KOH preps don't require a special microscope. No oil immersion, polarization, etc. are needed. You just need low/med power (10X, 40X, occasionally 100X). An adjustable condenser to increase contrast may help but you can do without it.


Carl Solomon, DPM, Dallas, TX



RE: Gary Dorfman, DPM Retires After 50 Years

From: Peter J. Bregman, DPM 


Dr. Gary Dorfman has officially retired from 50 plus years of podiatry. Dr. Dorfman is a former president of the American College of Foot and Ankle Surgeons. He has given much of his time and talent working in various aspects of podiatry and has helped thousands of patients and left his impression on his fellow colleagues.


Dr. Gary Dorfman


His most recent employment was at the Foot, Ankle, and Hand Center of Las Vegas. He finished his last four years of practice doing what he loves and creating bonds with his patients and colleagues that will last forever. Though he is leaving our profession, he will be fondly remembered for his contributions and we wish him well in his retirement.


Peter J. Bregman, DPM, Las Vegas, NV



From: David Gurvis, DPM


I also have a missed appointment fee. I find the “threat” alone reduces missed appointments. Do I apply the fee uniformly? No. Actually, I hardly ever use the fee unless a patient has been egregious in repetitive missing of appointments. What I find then is that if I apply the fee, the patient goes away. The desired result. They fire me and I don’t have to discharge them!


I don’t have the fee on new patients as it is too difficult to make sure that they understand my policy, but if they miss two appointments, I refuse to take them back. As always, there is common sense. Missing an appointment without a call later is frowned upon more than missing with a call later that indicates the patient is sorry and had a lapse in memory or perhaps a real reason.


David Gurvis, DPM, Avon, IN



From: Neil B. Levin, DPM, Mark K Johnson, DPM


We have been extremely pleased with the Konica Sigma CR units. We have three of them in different offices. The base unit fits on a countertop and we use our own X-Cels without any modifications or retro-fitting. It produces great images and and has excellent tools. Lease or loan payments are about $550/mo. for 60 mo. It was our best investment ever!


Neil B. Levin, DPM, Sycamore, IL


We went with the DR system A2D2 from Foz Networks (Zac Childress) , retro-fit to our X-Cel system in 2013.  Lease to own. The A2D2 is very reliable and have good support with minimal issues. Highly recommended.


Mark K Johnson, DPM, West Plains, MO