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01/27/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Carl Solomon, DPM
Dr. Gordon is a little short of completely characterizing the situation when he comments that we are one of the few professions required to accept negotiated rates. If an auto mechanic charges you based on an hourly rate chart, you have to pay him before he'll release your car. Even if we know our negotiated fee, in many instances we aren't even allowed to collect it. I pose the question: "In what other business is it required that instant credit be extended to all customers, and with terms that are undefined and difficult to enforce?"
Other messages in this thread:
03/07/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1B
From: Michael M. Rosenblatt, DPM
Dr. Hywnak provided a stunning new direction for podiatrists interested in becoming physician "associates." My podiatry license in WA State identified me as a "Podiatric Physician and Surgeon." I think this was helpful politically, and in WA State we had a good "podiatry practice law." I did not find the practice limitations of podiatry to be any particular obstruction or blockage to a highly satisfying and gratifying career.
But podiatry is literally hands-on. I say this, not derisively but proudly. This is true whether you choose a surgical or non-surgical podiatry practice. However, some podiatrists over the years sustain a kind of manual disability that may limit their ability to practice basic podiatry. Some, breathing in fomites from nail dust may develop a mild COPD. There are other reasons why it may not be possible to continue practice. For planning purposes, certification as a physician associate may allow a DPM who did NOT purchase disability insurance to continue in a fulfilling career.
Rather than criticize this opportunity, I suggest that some of us welcome it and utilize it if it fits your professional lifestyle. But like any other career, it likely contains both positive and negative attributes. In my Medicare Certified Surgical Center, I actually hired MD/DO anesthesiologists. I would never have assumed this possible or likely as a 2nd year DPM student! If you suggested this would happen to me, I would have laughed out loud. For me, podiatry opened like a flower in the most unexpected ways. I'm sure this career is not an easy qualification. I congratulate Dr. Hrywnak for this creative opportunity and request that my fellow DPMs not criticize him for opening doors for us.
Michael M. Rosenblatt, DPM, Henderson, NV
07/20/2022
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: David Secord, DPM
I like to comment on people in our profession referring to MD and DO medicine as allopathic and osteopathic and then putting ‘podiatric medicine’ in a separate category, as if podiatric medicine wasn’t allopathic medicine. The poll in question does this same thing. There are a certain finite number of medical theories out there, including allopathic, homeopathic, chiropractic, Native American Indian pan-theistic naturopathy, witch doctors, Eastern Indian Ayurvedic medicine, and a few others. Allopathic medicine has as its basis the idea of pathology from disease state: bacteria, virus, prion, spirochete, genetic dyscrasia, etc.
Unless I missed something critical in medical school, that’s the disease model we in podiatry follow as well. As such, podiatric medicine is allopathic medicine. Podiatry is often stated as wishing to contribute with "allopathic" providers in the area, as if WE were not allopathic physicians. One of the myopic tendencies in our profession is to separate ourselves in like manner from allopathy, which makes no sense to me. Podiatry follows the allopathic theory of medicine. We ARE allopathic physicians.
David Secord, DPM, McAllen, TX
01/17/2022
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Name Withheld
I have been on-staff at my local hospital with full surgical and admitting privileges for over 30 years. I have served on many hospital committees. Several years ago, at a Bylaws Committee meeting, the question came-up about medical clearance on the day of (outpatient) surgery. We usually have 2 H&Ps for each patient - a "Podiatric H&P" and an H&P from the primary with medical clearance. On the day of surgery, we must sign-off that there have been no changes since the H&P and no medical contraindication to the surgery.
The hospital administration objected to podiatrists signing this statement. Since we do not have medical residents, it was suggested that the house PAs or NPs examine and sign-off on our patients. Parity with allopathic physicians? It was implied that podiatrists did not have parity with advanced practice providers. I argued the question and protected the rights of our podiatry staff.
Name Withheld
06/01/2018
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Pete Harvey, DPM
Many years ago, I attended a meeting with Bob Levoy. He asked a show of hands how many of those present kept Saturday office hours. About three-quarters of the crowd's hands went up. He advised them to stop Saturday hours. He said we would not notice a drop in income and that our families were more important than our patients. He was right. I miss Bob Levoy.
Pete Harvey, DPM, Wichita Falls, TX
12/07/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Paul Busman DPM, RN
I had to laugh at the survey this week. Having left podiatry practice 9 years ago, I remained blissfully ignorant about what MACRA stands for. Only the U.S. healthcare system could come up with an acronym that contains, nested within it, another acronym (The C in MACRA stands for Child Health Improvement Program)!
I read what Wiki says about MACRA and found it to be the same kind of garbage that prompted me to leave practice, only much worse. I'm predicting more early retirements or career changes.
Paul Busman, DPM, RN, Frederick, MD
08/02/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1A
From Richard A. Simmons, DPM
Dr. Smith asks Dr. Siegel, “what makes him so special” because Dr. Siegel’s health is doing well because of ACA. My answer is a simple word: civilization. We live in a civilized society. I do not complain that I have to pay taxes for the parks in my city that I do not use; I do not complain about paying taxes for schools for children I did not have; I do not complain that I supplement a transit system that allows your patients access to your office; I do not complain that I pay taxes to build the roads that your patients use to travel to your office. These are the prices we pay for civilization. There are many who have that independent attitude that “I have mine; screw you!”
For you, I say, there is plenty of land available where many can go to live self-sufficient: you can sink your own wells, handle your own sewage, farm your own land. Have at it. That civilization can provide medical treatment and care for Dr. Siegal is a win/win situation for all of us: 1) he is working member of society who I am sure pays taxes, etc., and 2) we have a very intelligent man who is able to contribute to the well-being of citizens in his community by being a podiatrist. You see, those children that I pay taxes for their education, one day, they will take care of me. This is what we call civilization.
Richard A. Simmons, DPM, Rockledge, FL
06/24/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1B
From: Jay Kerner, DPM
Like any prescription with possible psychoactive side-effects, medical marijuana must be prescribed appropriately and with careful selection of patients. For conditions running the gamut from ischemic pain, diabetic neuropathy to delayed onset muscle soreness, medical marijuana would certainly be appropriate.
I completed the four-hour NY State course for medical marijuana prescribers. However, when applying for the next step, I was told by the NY State Health Department that prescribers must be MDs. I was also informed that this could only be remedied legislatively.
Jay Kerner, DPM, Rockville Centre, NY
06/24/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1A
From: Randall Brower, DPM
I would not be in favor of prescribing marijuana if it was legal, assuming it is traditionally smoked. I argue that I would be liable for any patient who develops lung cancer or other cancers from smoking it. Until they can FDA-approve, study it, and put it in reproducible delivery systems that deliver regulated quantities for proper treatment selection, I refuse to jump on that boat.
That said, I have seen anecdotally in my practice many patients who get real relief of pain from marijuana, and they actually have quite a significant decreased use of narcotics post-surgically.
Randall Brower, DPM, Avondale, AZ
02/08/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Stephen Doms, DPM
I recall two occasions when degree changes were granted in a very short period of time. In California in the 1960s, the CMA tried to eliminate DOs by having them change to MDs and then closed the DO schools. I think that about 85% of DOs turned in their degrees to obtain an MD certificate.
Then in the late '60s or early '70s, the DSC chiropodists were able to change to DPM degrees with evening and weekend courses at the colleges of podiatric medicine, specifically with courses in pharmacology and surgery. It can be done.
Stephen Doms, DPM, Hopkins, MN
11/26/2015
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Ron Freireich, DPM
Not only are we not getting incentives or payment for the work we do in the form of PQRS measures, but it costs us not to be penalized. I checked with the PQRS Registry today recommended by my EMR vendor, and it will cost $500 for the first NPI/tax ID combination that we bill under, and $250 for each additional combination. What's wrong with this picture?
Ron Freireich, DPM, Cleveland, OH
11/11/2015
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1B
From: Paul Sommer, DPM
A one-day strike wouuld be highly unlikely and not legal. Another angle would a cash only day.
Paul Sommer, DPM, Valparaiso, IN
11/11/2015
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1A
From: William Deutsch, DPM
American physicians should regard the happenings in Great Britain as junior doctors ballot for a strike to oppose unsafe working conditions in hospitals. Long hours, reduced overtime, a paltry pay raise has the junior doctor's (residents) Union ready to vote. They have the full support of the BMA. They're not talking about a one-day strike which would go unnoticed. The advantage they have is their strike is against the government which salaries NHS doctors.
Who is the one-day strike in America directed against? The only effective response American physicians can offer is non-participation in all insurance plans, and not just for a day. An insurance company that has no participating physicians is out of business. PPACA reform began and ended with insurers. The fallout from PPACA on the landscape of healthcare wasn't accidental.
EMR and MU are the government's 'common core' response to physician-administered healthcare. They are administrative burdens which only help bean counters, while leaving doctors to drown in a sea of confusion. Like the good lemmings we are, we march dutifully to our own demise.
William Deutsch, DPM, Valley Stream, NY
11/10/2015
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Eric Trattner, DPM
A strike traditionally is a stoppage of labor, essentially holding hostage an industry in the hopes of receiving better terms. The power of a strike is both in the scope of participation as well as the uncertainty of its length. The longer a strike goes on, the more deeply will the loss of service be felt, especially with 100% participation.
In a proposed one-day physician strike, I question first the level of participation, mostly due to the fact that there is no union, and therefore no "bosses" to come down on the "scabs" who do not strike. But mostly, there is no real threat. No one actually believes essential medical care would ever be withheld from sick or injured patients. Nor should it ever! However, even in a scenario where all elective care IS withheld for 24 hours, for what purpose? There is no one in any position of authority with whom to bargain, and even if there were, we would be striking from a position of weakness. "Don't worry, tomorrow we'll be back on the job."
While a one-day strike may attract some attention to "our plight", I doubt it would garner any sympathy, let alone any positive results. The fact is we have very little power as individuals and, as I've seen over the past 25 years, it appears neither do our professional organizations. The only ones with any true negotiating power are the large groups and hospitals. Sure, we can threaten to drop out of insurance plans, but that goes right back to the issue of participation. The other 3 or 10 podiatrists on my block will still accept all insurance plans.
Eric Trattner, DPM, Cleveland, OH
01/17/2015
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Tip Sullivan, DPM
The main point that I gleaned from Dr. Smith’s post was that the responding podiatrists generally are not experienced or well trained in surgery. I was not quite clear on the paradigm change he was suggesting (fewer people doing more surgeries?) The problem that I had with his post was that this Quick Survey is just that. It doesn't break things down into procedure types or difficulty. If a podiatrist did 5 hammertoe surgeries per month for 20 years, he would have done 1,200 hammertoe surgeries. That is a lot of experience, board certified, or not.
Tip Sullivan, DPM, Jackson, MS
Editor's note: By "fewer people doing more surgery," we believe Dr. Smith is advocating two types of podiatrists - surgical and non-surgical, and suggesting that each type essentially adhere to this division. Podiatric surgeons would only perform foot and ankle sugery, and non-surgical podiatrists would only provide all other foot and ankle related services.
10/30/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Elliot Udell, DPM
There are some doctors whom I go to who have signs telling patients not to use their cell phone at any place in the office. I've often wondered why some physicians feel this way. Is an office like a jet, where they are afraid that the cell phone will interfere with electronic communications to the pilot? Will someone talking on a cell phone interfere with the way a syringe operates? Will a nail nipper explode because "Mrs. Cohn is talking to her husband in the waiting room?"
Yes, I find it discourteous if a patient is talking on the phone when I need to take a medical history. In general, however, I find that cell phone use is a worthwhile diversion, and I actually encourage people to talk on their cell phones while I am giving an injection. It works better than ethyl chloride, plus I get great PR. The patient tells his or her friend that I gave them a near painless injection. It's also a lifesaver if I am running late. Someone who is a cell phone junkie will never look at his or her watch.
10/22/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Don Steinfeld, DPM,
I must be getting old! I didn't see my favorite fixation method as an alternative. Alas, it is out of fashion. I favor Orthosorb absorbable pins. Disclaimer: I have no relation of any sort with the makers or sellers of this product. My rationale for why this is by far the choicest fixation for your next Austin is as follows: The pins are only present for six weeks and then are gone. I have never had failure of or needed to remove a pin. This is a simpler method than screws and requires no antibiotic coverage.
I have used K-wires, buried them and had to remove them, and exposed, which creates a wound which carries other baggage. Although it's a little tricky to learn, Orthosorb is reliable, fast, and dependable. The only problem I ever had was putting a pin in too far once. That caused moderate discomfort plantarly until the pin dissolved in six weeks. My feeling is that plates and screws fit the ego more than the Austin. Sometimes old is good.
06/16/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: George Jacobson, DPM
Be careful what you wish for! After having a decline in the practice volume the first three months, we all of a sudden see a small increase in patient volume. What happened was people and plans were in limbo in the first quarter and through the enrollment period. We lost some patients to new plans; but now, out of the 50+ marketplace plans, somehow we are on one of them. That has generated some new patients. But here is the but: there are limitations that we have no control over. We will see limitations to everyone in a single payer system. The limitations will no longer be limited to a one of many plans, but to everyone.
I refer all my surgical cases to my colleagues. I recently referred out a patient with a...
Editor's note: Dr. Jacobson's extended-length letter can be read here.
06/14/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Jon Purdy, DPM
Irrespective of the many facets of this discussion, consider another option. Where would one be if they took the money they would pay monthly and split that between a $150 per month catastrophic health plan and the balance in a tax deferred health savings account at an early age? Couple that with placing the monies taken by the government in withholding your entire working life for a future 80/20 plan (Medicare), that you can’t use until you reach age 85, and putting that into a tax deferred health investment account. You would be a multi-millionaire capable of funding your own healthcare while maintaining the choice to receive the best care possible.
06/12/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: John Moglia, DPM
Why hasn't extending Medicare as a single payor system been prominently considered? I pay $2,000 month in healthcare premiums, and I seldom utilize the benefits as I have a relatively young and healthy family. My premium could help subsidize the over-worked Medicare program. As a healthcare provider, the advantage of knowing that I will get paid, and how much would be an improvement.
06/10/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Jim Shipley, DPM
I'm somewhat shocked and amazed at the current percentage given at this week's poll on having a single payor system. While I can understand the frustration that we are all going through when dealing with insurance companies, I feel my experience can lend some insight into this insurance dilemma and what possibly a single payer insurance scenario would bring.
Even though born in the U.S., I grew up in Canada until adulthood, after which I moved to London, England for two years before moving back to the States. I feel well rehearsed in all three countries' healthcare systems. Canada and England both have...
Editor's note: Dr. Shipley's extended-length letter can be read here.
02/26/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Michael Forman, DPM
Little shocks me anymore. However, the initial response to PM News' poll question regarding college faculty providing testimony in liability cases threw me for a proverbial loop. I understand how my colleagues, particularly those who have been sued, feel about someone criticizing their work and attacking their pocketbook. I know that from personal experience. I also know that most malpractice suits are frivolous. As I recall, the latest statistic I read said that only 5% of medical malpractice claims go to court.
But please, for a moment, put yourself in the place of a patient who was harmed by a medical mistake due to the FAULT of a medical provider or institution. Shouldn't that person be entitled to some compensation? If there is a bad result which was not due to an error, that becomes the "sh*t happens" defense. I don't have the answer to the medical liability problem, except to say that limiting a portion of our profession, who we hope, practice at the highest level of our profession, is certainly not an answer.
02/12/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL) - PART 1B
From: Steven J. Kaniadakis, DPM
What do the topics of a three-year surgical residency, the results of the recent survey about the percentages of podiatrists doing RFC, and the past survey about percentages of DPMs performing bone versus soft tissue surgeries indicate about today's podiatrist? Are we training our residents for the vision we wish to achieve or for the realities of today's podiatrist?
02/12/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Keith L. Gurnick, DPM
As a 4th year podiatry student in 1979 at CCPM, I did an externship in the office of Dr. John Weed, who practiced in San Jose, CA. He was one of my favorite biomechanics teachers and my expectation was that during the two weeks in his office, I would improve only my biomechanics skills by observing him performing range of motion exams, muscle testing, gait analysis and casting, Rx writing, and dispensing orthotics on his patients. Because this was his main teaching subject, I naively figured that's what he probably did exclusively in his private office practice.
He had many satisfied and happy patients, and he was a well-rounded podiatrist of his time. Sure he did biomechanics, but he also clipped toenails, he trimmed calluses,...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
01/29/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Ed Davis, DPM
Dr. Solomon recently made the following comments: "Even if we know our negotiated fee, in many instances, we aren't even allowed to collect it. I pose the question: "In what other business is it required that instant credit be extended to all customers, and with terms that are undefined and difficult to enforce?"
He is correct in that healthcare providers are extending credit to patients for services rendered. That is the insurance game known as "time value of money" in which there is a monetary value to the...
Editor's note: Dr. Davis' extended-length letter can be read here.
01/23/2014
RESPONSES/COMMENTS (PM NEWS QUICK POLL)
From: Sloan Gordon, DPM
I offer a standing ovation to Dr. Sasiene and Dr. Garoufalis with respect to their letters and their 'campaign'. Reading the NY Times article this weekend about how "egregious it is" for doctors to make money from ancillary services turned my stomach. Oh those RICH doctors.
The article described how a dermatologist doing Moh's surgery had to take the patient to the OR for a plastic closure and graft of their face. Not a word about...
Editor's note: Dr. Gordon's extended length letter can be read here.
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