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RE: Podiatric Residency Crisis - Where Are We? (Robert Kornfeld, DPM)

From: Ivar E. Roth DPM, MPH

Concerning Dr. Kornfeld’s observations, here is what happened recently with some highly qualified 2013 graduates who did not match, and the preceptorship program that I offer. These graduates initially said they wanted my program, so I accepted them. Shortly afterwards, they said they needed some more time to make one last effort to get a residency program and asked if they could put my program on hold. I said yes. After their drop dead acceptance date passed, they again asked for more time. Again, they were not matched.

They were scheduled to start on June first. They then notified me that they wanted to take a month-long vacation, so I said okay. Just before going on vacation, they said that they could not now promise to take the program unless I agreed that they would have the full ability to apply to programs as they came up during the year, and that if they were accepted, they would leave my program. I said "no" at that point.

I was prepared to pay them very well for a year and give them excellent training. It seems like they want to have their cake and eat it too. I bent over backwards to help them out, and they seem so unappreciative of the opportunity made available to them. So now, they will probably do nothing in podiatric medicine for the next year. What a shame.


Ivar E. Roth DPM, MPH, Newport Beach, CA,

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RE: The Bell Tolls for Us (Mark S. Davids, DPM)

From: Steven J. Kaniadakis, DPM

The post from Mark S. Davids, DPM is right on point. It is a great analogy, only if it were "Ma Bell." My practice experience discovered that there are bundles and packages of supplies and services -like your T.V., Internet, phone. The price keeps going down for the bigger bundle or package, so-called "global bundle" or "global package" in podiatric coding of supplies and services rendered. Yet, the expectation is that providers of healthcare must provide the maintenance while the bundle of "what's included" gets bigger.

Healthcare licensees need an "unbundling rule" like that of licensees of FCC. Meanwhile, pay the toll for extra marshmallows in your Starbucks coffee, since it is not part of the bundle or package.


Steven J. Kaniadakis, DPM, St. Petersburg, FL,



RE: Compounding Pharmacies (Marc Katz, DPM)

From: Allen Jacobs, DPM

Dr. Katz's letter expressing his concern over the present costs of compounded topical pharmaceuticals is reflective of medicine in general, and his concerns are not unique to the compounding industry. How much does Dr. Katz charge for orthotics? Probably more than he gets for a digital arthroplasty. How about CAM walkers? Probably more than he gets for a level-2 office visit. And how many orthotic labs bid for our business?

The assertion that these pharmacies add components to drive up the cost is ridiculous. The pharmacies may only dispense what...

Disclosure: I have lectured for TPS and Bellevue pharmacies on these subjects.

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



RE: Staff Makes it Difficult to Get Appointments

From: Gregory B. Nellis, DPM

I completely see the potential for office sabotage that is being discussed. However, there are two sides or more to a lot of things, and this may be one. Maybe some of your staff are looking at the book, at you, and listening to callers and trying to protect you. How many "black toes" have you rushed in for a little dried blood on a thick hallux nail? We don't know how to say no, or not today. If we were our own receptionists, we would never go home.

The only suggestion I would make is that if questionable in any way, they put the patient on hold, give you their chart or fill you in on the new patient, show you the book, and ask you how to fit them in. That should be a rare instance. Part of a good receptionist's job is to protect you, while availing patients to care as can be done reasonably.

Gregory B. Nellis, DPM, Gloversville, NY,



RE: Staff Makes it Difficult to Get Appointments (Bryan Markinson, DPM)

From: Robert Scott Steinberg, DPM

Not withstanding Dr. Markinson's practice management expertise, and the efficiencies he achieves by depending heavily on his staff, there are the realities of private practice that most of us still have to face on a day-to-day basis. First, let's go back to reality and the post that started this discussion. "Name withheld" was quite upset to hear what his/her staff was pulling, and had a secret shopper confirm his/her suspicions. Except for Dr. Markinson's off-topic scenario, it is very clear that staff can hurt a doctor's practice if they are not carefully monitored. Things are simple in my office. My staff asks. Novel, huh?

Robert Scott Steinberg, DPM, Schaumburg, IL,



RE: APMA Pinterest Page (Crystal Holmes, DPM)

From: Brian Kiel, DPM

I recently wrote a letter on this forum excoriating the APMA for its incompetence and irresponsibility in the development of the Pinterest site Beat-Bunion-Blues. A response to my post was published on this site several days ago and it is even more ridiculous and irresponsible than the site itself.

Crystal Holmes DPM, the chairperson of the APMA communications committee stated, "images (not the source of the images) are the content users are interested in)." So, according to this web wizard, people looking for advice about bunion treatment are only looking for pictures, not...

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

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