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From: Arnold Ross, DPM, Burton J. Katzen, DPM


I enjoyed the three-year program. Unfortunately, the plan to have more grads was questionably calculated. In California, the old CCPM had approximately 100 students per class with a podiatric hospital and fully functioning orthotic lab. Now, we have two schools in California with approximately 100 students or less in total, and no hospital or orthotic lab in either.


Arnold Ross, DPM, Los Angeles, CA,


I cannot believe that anyone in our profession could possibly vote for the 3-year podiatry curriculum. Before I looked at the results, I thought the voting would be less than 1%. First of all, as one of my colleagues stated, there is way too much to learn for even four years. Also, for those of us who have been around for over 40 years, if you think we were looked down upon by our medical colleagues and the general public in the past, this would be a public relations disaster, not to mention a credentialing disaster for hospitals, etc.


One viable alternative would be a 6-year college/podiatry degree program like Hopkins and several medical schools have, or at least I know had in the past. This would especially be a viable alternative for schools affiliated with undergraduate schools like Temple. Also, we're the only profession that is trying to force every graduate into becoming a surgeon with a 3-year residency to even get a license in most states. This is extremely detrimental and costly to the students wishing to provide for patients needing other types of care, and for our profession in general.


Burton J. Katzen, DPM, Temple Hills, MD.

Other messages in this thread:



From: Don Peacock, DPM, MS


I am a strong advocate of epidermal nerve biopsies. They play a vital role in my clinical practice. The procedure has many advantages over traditional ways of monitoring small nerve fiber neuropathy. The procedure is minimally invasive and can give quantifiable empirical data to prove the presence of unmyelinated small nerve fiber neuropathy. It has the added benefit of greater sensitivity compared to  traditional nerve studies. The study is repeatable and can be used as a marker for instituting therapeutic modalities and monitoring nerve regeneration. I would not want to practice without the use of these studies. Our neuropathy patients are some of the most miserable patients with respect to their noxious pain levels. These patients need to be treated aggressively and completely. This absolutely includes the use of epidermal nerve biopsy. 


All procedures have potential risks, and we need to take into account certain health aspects that are potential contra-indications. Diabetics with adequate circulation should not be excluded from a minimally invasive epidermal nerve biopsy. If cellulitis occurs, treat the complication accordingly. For the majority of our neuropathy patients, the information received from the epidermal nerve biopsies represents a valuable aspect of treating them along with more aggressive interventions such as decompression surgery, etc. 


Don Peacock, DPM, MS. Whiteville, NC



From: Elliot Udell, DPM


Dr. Hurchik is correct. There is massive money to be made by not only podiatrists doing these biopsies but by numerous pathology labs that are promoting these tests at our conventions and in journal ads.


At a seminar I attended, there was a med mal defense attorney lecturing about a case he was defending where the podiatrist was sued for doing a nerve biopsy on a diabetic who subsequently developed a severe infection from the wound created by the test. One of the questions asked of the defendant was why he needed to do the test in the first place and could the information it provided have been acquired from lesser invasive tests. Could the patients clinical history combined with nerve conduction studies have provided the same clinical information?


There is a time and a place for these biopsies, but we must all ask whether the benefit of doing them on every diabetic patient with neuropathy and/or reduced vascularity outweighs the risk.


Elliot Udell, DPM, Hicksville, NY



From: Paul Stepanczuk, DPM


I have performed many punch biopsies for nerve status over the last several years. I have never had a cellulitis problem or even delayed healing. Betadine prep is utilized and patients are given instructions for daily care until the area is fully healed.


The reimbursement is low; the biopsy is not performed for reimbursement. Instead, I use it to see if something as potentially costly as Metanx would be warranted over an extended period of time.


Paul Stepanczuk, DPM, Munster, IN



From: Joseph Borreggine, DPM, Steven Kravitz, DPM


I suggest that the Florida Licensing Board Members contact their local insurance agents to obtain an "umbrella policy" which will cover any litigation concerns on this matter. But typically, you are most likely indemnified by the state, and the state association may carry insurance for this type of issue. You may want to personally carry an umbrella policy of $2 million, which is not particularly expensive. These policies cover non-criminal acts.


Joseph Borreggine, DPM, Charleston, IL


Directors and officers insurance protect their board members in the event they are sued for the decisions they may on behalf of the organization they serve. Unfortunately, many state medical boards do not provide same. This is an issue and those volunteering to serve should consider requesting the organization of interest to do so. Pricing can vary, so it is helpful to investigate and purchase coverage for those services specifically provided by that organization.


Steven Kravitz, DPM, Executive Director, Academy of Physicians in Wound Healing



From: Michael J. Trepal, DPM)


A recent posting by Dr. Dave Williams and subsequent responses raised the question of pharmacogenetic testing and therapy. At the New York College of Podiatric Medicine, we teach during the first year, a year's course in human genetics. The first semester is Introduction to Human Genetics followed by a second semester course in Molecular Biology/Molecular Genetics. In the first semester, students learn classical Mendelian genetics, with emphasis on genetic diseases caused by single gene defects. A genetic counselor from the Department of Genetics and Genomic Sciences, Icahn School of Medicine of Mount Sinai gives a guest lecture on how to take a pedigree and each student is required to draw their family's pedigree. In the second semester, emphasis is on precision/personalized medicine, including pharmacogenetics/genomics.  


The genetics of common complex diseases including Type 2 Diabetes is studied in depth. The Human Genome Project and ways to identify and study genes are explored. Lectures on use of DNA sequencing in clinical medine and pharmacogenetics are given by expert guest lecturers from the Department of Genetics and Genomic Sciences, Icahn School of Mount Sinai. The importance of genetic variants in determining the correct drug/dosage is discussed. The future role of precision/personalized medicine in podiatry is also emphasized. The course director at NYCPM is working with the Council of Faculties to include genetics in the podiatric medical school curriculum, and the working group has already decided on objectives. 


We believe that our year-long genetics course prepares our student well for future changes in Podiatric Medicine and introduces them to the concept of precision/personalized medicine including pharmacogentics.


Michael J. Trepal, DPM, NY, NY



From: Dave Williams, DPM, Pete Harvey, DPM


I also have Practice Fusion. The easiest way I have found to upload images is to take a “screen shot” of my computer while viewing the image, then upload it into the Practice Fusion documents section.


Dave Williams, DPM, El Paso, TX


I would keep them separate. Be sure that each program is backed up daily, securely, and off-site. Then, run periodic checks to make sure the back-ups actually worked and can be recovered.


Pete Harvey, DPM, Wichita Falls, TX



From: Simon Young, DPM


I know Dr. Feinberg and his skills well. I'm very proud of him. He will be an exceptional residency director and produce exemplory residents (our future colleagues) that we can all be proud of and who will advance our profession.


Simon Young, DPM, NY, NY



From: Leonard  A. Levy, DPM, MPH


Dr. Dave Williams poses a question about pharmacogenetics. His question is very timely in that the medical genomic revolution is now underway, incited by the identification of the human genome more than a decade ago. Yet virtually nothing regarding genomics is found in the podiatric medical literature and little emphasis is provided on medical genomics in the podiatric medical education establishment. Genomics involves the interaction of multiple genes with the environment and is relevant to the prevention, diagnosis, and treatment of many of the most common diseases such as diabetes, cardiovascular conditions, cancer, and likely also to many podiatric medical conditions (eg., hallux valgus, club foot, etc.).


Also included is pharmacogenomics which identifies a drug dose specific to an individual rather than providing the same drug dose to all individuals (i.e., personalized or precision medicine). The time is long overdue for the podiatric medical profession to identify its role in medical genomics - the sooner the better.


Leonard  A. Levy, DPM, MPH, Ft. Lauderdale, FL



From: Wenjay Sung, DPM, Tom Fusco, DPM


I understand the question of these Chinese vendors contacting various doctors to attend and speak at illegitimate conferences. I too have been solicited by various outlets for GFAC in China. Because I was unsure if some Chinese company hijacked Dr. Hardy's conference, I checked his website, but there isn't any updated info.  


So I implore Dr. Hardy to update the GFAC website, so there's no confusion. Right now, the only site with info for GFAC 2017 is This company BIT is notorious for fake conferences throughout China.


Wenjay Sung, DPM, Los Angeles, CA


I was at the conference held in Cleveland in 2016 and I can assure you it was very much a real conference. Great talks and a much better run conference, better talks than I have ever attended. Dr. Mark Hardy is the one still heading this up and they announced at the 2016 meeting that the 2017 would be held in China. I highly recommend anyone who wants to do some traveling to attend this conference. I have no affiliation with GFAC. 


Tom Fusco, DPM, Fort Walton Beach, FL



From: P David Applegate, DPM


I'm in the midst of opening a practice and have found a number of ways that technology can make for a nimble startup. With recent advances in cloud computing, an entirely cloud-based office is possible. Gone are the days of expensive server installations with costly monthly IT service contracts. With a modern EHR like Medi-Touch, much of the practice is handled via web browser. Patient registration and check-in can be handled entirely through the EHR, saving time and administrative costs over a traditional paper system. In addition, charting, surgical consent signing, and patient instruction on everything from stretching to wound care can all be done electronically.


Medi-Touch is what I've elected to go with, but there are a number of others out there like DrChrono and Practice Fusion that can be considered. The decision is entirely personal, but can be overwhelming. The same goes for digital x-rays. I recommend a good consultant to help you decipher between all of the options out there and aid you in negotiating competitive pricing. Again, the choice is entirely personal, but I've retained Cindy Pezza with Pinnacle Practice Achievement and have been very happy with the service I've received so far. 


P David Applegate, DPM, Houston, TX 



RE: Orthotics and Insurance

From: Michael Forman, DPM


Our group handles orthotic devices in this manner:

1. The physician discusses his findings and proposed treatment (orthotics) with the patient.  A scan may or may not be done at that visit.

2. The physician sends a computerized note to our billing department with a diagnosis and code for the orthotic.

3. The billing people call the insurance company and determine coverage and payment.

4. The billing people then call the patient, explain the benefits, and then determine if they wish to go further.

5. If the orthotic devices are not fully covered, a 50% deposit must be made and the patient is told that the remainder must be paid before dispensing.


While this may sound like a long process, it is not, and can easily be accomplished in a small practice as well.


Michael Forman, DPM, Cleveland, OH



RE: New Balance Shoe No Longer Made in USA

From: Robert S. Steinberg, DPM


New Balance's very popular 1260 running shoes are no longer made in the USA, but in China. New Balance failed to let anyone know. I had a patient complain to me that the shoe that I said was made in the USA, wasn't, I told him to take the shoe back, and complain. 


Robert S. Steinberg, DPM, Schaumburg, IL



From: Lori M. DeBlasi, DPM


I would like to thank Dr. Lee Rogers for his recent posting regarding Funding for Fellowships. His response, however, incorrectly stated “post graduate training must be accredited by the APMA and lead to board certification. Some podiatric fellowships are eligible to receive 50% funding for what is essentially a "4th year" of residency.”


The Council on Podiatric Medical Education (CPME) is an autonomous, professional accrediting agency designated by the American Podiatric Medical Association (APMA) to serve as the accrediting agency in the profession of podiatric medicine. As such, CPME, not APMA, approves residencies, fellowships, and continuing education providers, and accredits colleges of podiatric medicine.


Only CPME-approved fellowship programs may be eligible to receive federal funding; however, fellowships are not considered to be a fourth-year of residency. A podiatric fellowship is an educational program that provides advanced knowledge, experience, and training in a specific content area within podiatric medical practice. Fellowships, by nature of their specific content concentration, seek to add to the body of knowledge through research and other collaborative scholarly activities. Podiatric fellowship education is a component in the continuum of the educational process, and as such occurs after completion of an approved residency. The Council requires fellowships to afford training above and beyond that which is afforded during residency.


Additional information related to approval of fellowship programs, including a list of CPME-approved fellowship programs, is available at CPME’s website, select “Fellowships."


Lori M. DeBlasi, DPM, Chair, Council on Podiatric Medical Education



RE: Kudos for Surgical Section in Podiatry Management 

From: Ed Cohen, DPM


Podiatry Management did a terrific job on the section devoted to surgical podiatry. I especially enjoyed the articles on "Comtemplating the Akin" by Bradley Castellano, DPM and "The MIS Akin Osteomtomy" by Donald Peacock, DPM. The different surgical cuts were well illustrated as were Donald Peacock's treatment of ulcers, osteomyelitis, hallux varus, and hallux limitus. Podiatry Mmanagement Magazine is to be commended for bringing this material to the podiatric community.


Ed Cohen, DPM, Gulfport, MS



From: Simon Young, DPM


I am in full agreement with Dr. Markinson. His remarks are so true and germane. 10 minutes for a bilateral significant osseous procedures is ludicrous and riddled with potential poor results, and we wonder why malpractice premiums are so high. Can you envision what a lawyer in court would say?


Furthermore, it's infantile behavior to brag about OR time, and gives insurers more reason to trivialize our worth and pay us less.  No other specialist brags about such insignificance, even if it's true in their sphere. Shame on us.


Simon Young, DPM, NY, NY



From: Kim Antol


The easiest way, with little or no expense, to create digital images from film is to simply put your film up on a view box and take a picture with a digital camera. These can then be easily imported into your imaging software or emailed to the requesting party.


Kim Antol, President, Sigma Digital X-Ray



From: Doug Milch, DPM, Robert S. Steinberg, DPM


I use a hair dryer for 10-15 seconds and it loosens the top.


Doug Milch, DPM, Asheville, NC


Since we are on the subject, I want to remind everyone of the dangers of using Original Barge Cement. Barge is heat-activated, contact cement, which means you should be carefully using a heat gun to not only dry the cement, but to heat activate it. Remember the hoods in the chemistry lab - that's really what you should be using. I believe activated carbon will filter the volatiles, if you wear a breathing filter; but if you don't vent, everyone in the office is exposed. An alternative is to take it outside. You need plenty of ventilation to the outside, and may be required to "scrub" the exhaust, by local or state ordinances, or the EPA. This stuff is highly toxic to the liver.


Robert S. Steinberg, DPM, Schaumburg, IL



RE: Second Place for Best Tasting Honey   

From: Wm Barry Turner, BSN, DPM


This is my first competition and I learned a lot! I encourage all my peers who have a little outside room to try their hands at apiary. Recently, I read that bees are considered an endangered species.  Raising bees can be tax deductible and, in some places, may qualify you for an agriculture break on you homestead taxes. You would not believe how my blueberries harvest has grown since I started raising bees.


Dr. Wm Barry Turner and his award-winning honey


I love podiatry, but sometimes at the end of the day, I need something to distract me and maybe give me a little buzz.


Wm Barry Turner, BSN, DPM, Royston, GA




I am also interested to know if the ABFAS will develop some type of senior or honorary designation. I was initially certified by ABPS in 1993 and recertified in 2003. I did not recertify in 2013 because I was working part-time and not doing surgery; therefore, I was not on staff at the hospital or surgery center. I have now been in practice for 30 years and will continue (because of necessity) practicing. Due to losing by active certification, I was discontinued from my local physicians group that certifies one for insurance company membership.


My intelligence/competence has not changed. I continue to keep updated. I know some of the Board members think that if you are not actively doing surgery, you cannot continue being certified. However, we did earn this title and there should be some certificate regarding this. I know my PHO would have accepted a letter or honorary certificate from the ABFAS so that I could maintain my insurance status. I am sure there are others in my position. Am I the last solo practitioner who wants to maintain a livelihood in all respects?


Name Withheld



From: Bruce Myers, DPM


Interesting blurb on Primus, Metatarsal the First, but all students should know that peroneus longus is no longer called that in anatomy. It is now called fibularis longus and his brother is called fibularis brevis.


Bruce Myers, DPM, Rochester, MI



From: Philbert Kuo, DPM


In a follow-up to my previous post, I whole-heartedly agree that one should do his/her homework on the different carriers. It does not hurt to ask your carrier for a better quote. I did, and they knocked down the price by $2,000. Of course, they were $5,000 above everyone else, but I think you get the picture. As far as disclosures, I have never been paid by any insurance company or insurance broker for any services.


Philbert Kuo, DPM, Chesapeake, VA



From: Elliot Udell, DPM


Dr. Cowin cites an interesting case. It does and does not have relevance to podiatrists. In the case cited, a patient was given antidepressants and the following day went on to commit suicide. The court felt that the doctor could have done more for the patient's mental state than just change the medication.


What is relevant is that although we all see patients who have mental health issues, the treatment is out of our scope. The doctor described in the case was clearly addressing his patient's emotional disorder. Even though we prescribe antidepressants such as Cymbalta, we are using it to treat foot pain, not clinical depression. Hence, we could not be held liable for not properly managing a mental health disorder in our practices.


I frequently refer patients to psychiatrists, clinical psychologists, and psychiatric social workers. Unlike referrals to surgeons or endocrinologists, a mental health referral has its own set of challenges. Utmost time and professionalism is essential because if a patient thinks that you are accusing him or her of "being crazy", he or she will not only decline your advice but might take leave of your podiatric services as well.


Elliot Udell, DPM, Hicksville, NY



RE: Prescribing Medical Marijuana by Podiatrists (Jay Kerner, DPM)

From: Elliot Udell, DPM


As Dr. Block indicates, our ability to prescribe marijuana for foot-related conditions is an evolving situation and will vary from state to state


That being said, unless marijuana is proven to be an absolute panacea for certain foot conditions, I will not prescribe it my practice. The benefit of prescribing such a "medicinal" would be far outweighed by the rendering of my office into a magnet for drug addicts.


Elliot Udell, DPM, Hicksville, NY



RE: OSHA Penalties Increase Significantly

From: Joseph Borreggine, DPM


The penalties (sometime referred to as fines) that the Occupational Safety and Health Administration (OSHA) imposes on employers that are found to be in violation of OSHA Standards have recently increased significantly. Prior to the current increase, each serious violation could receive an OSHA penalty of up to $7,000. But now, each serious violation can receive a penalty of up to $12,500. That’s roughly an 80% increase.


Consider the fact that a typical small healthcare employer might be charged with several serious violations during a single OSHA inspection. Four or five violations at 12K each can quickly add up to penalties in the $48 to $60 thousand dollar range. And the penalty for a single violation that OSHA judges to be willful on the part of the employer is now permitted to be as high as $125,000. 


Source: Stericycle, Inc.


Joseph Borreggine, DPM, Charelston, IL



From: Randolph Fish, DPM


This is an interesting subject and I thank Dr. Levy for publishing on it. We used an abbreviated REALM test on 41 patients in our wound center recently. The test was distributed among patients in percentages equal to their insurance, so any one group was not targeted. The resultant average score in our clinic was ages 5-7 years, basically at a pre-school level. This may be one reason that patients do not follow instructions, even when they say they understand. 


Randolph Fish, DPM, Tacoma, WA