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01/16/2015
RESPONSES/COMMENTS (PM QUICK POLLS)
From: Arden Smith, DPM
In a recent "Quick Survey", 80% of the 815 respondents performed less than 10 surgeries in a month. If the respondents who performed "0" were eliminated, it would be 60%. Only 6.6% did more than 20 surgeries a month. Would you have heart surgery, cancer surgery, orthopedic surgery, plastic surgery, or ANY SURGERY from someone who did less than 10 procedures in a month on a regular basis? You would probably want someone expert in a particular procedure.
Is it time for a change in paradigm? Should fewer people be doing more surgery [with the potential to lose their board certification if the "stray" out of a defined scope and "bite the hand that feeds them"]?
Arden Smith, DPM, Great Neck NY
Other messages in this thread:
04/04/2023
RESPONSES/COMMENTS (PM QUICK POLLS)
From: Arman Kirakosian, DPM
I am a residency director in San Francisco, and I was present at the Certification Summit on March 20th. The ideas generated at the Summit are worthy of strong consideration and I am thrilled that so many podiatrists across the profession are all on the same page regarding what the future of certification should look like. Hopefully, everyone realizes how special our profession is.
Something that has gone under-reported from the Summit was perhaps the most important finding. We reviewed the consensus of about 900 APMA-surveyed DPMs and heard many testimonies of unfairness and hardships from well-trained podiatrists that lead to reduced practice opportunities. It was nearly unanimous that:
1. There is a problem with podiatric board certification, 2. There should be one board in podiatric medicine and surgery, 3. The pathways to certification opportunities should be inclusive of all those left behind, 4. The timeline to achieve this should be accelerated.
Our training has evolved, but not all of our board certification processes have adapted with the change. There is now a single, standardized, 3-year Podiatric Medicine and Surgery Residency (PMSR). For every ACGME (MD) residency program, there is a single recognized board and a single tier of certification. Additional certifications are available with additional training. This is the future that we should be working toward for podiatry.
Arman Kirakosian, DPM, San Francisco, CA
03/13/2023
RESPONSES/COMMENTS (PM QUICK POLLS)
From: Jeffrey Klirsfeld, DPM
If we were to become PAs as well as with our DPM degree, would that mean a difference in medical malpractice insurance premiums? It would have to go up. We even might have to carry two policies.
Jeffrey Klirsfeld, DPM, Levittown, NY
03/10/2023
RESPONSES/COMMENTS (PM QUICK POLLS) - PART 1A
From: James DiResta, DPM, MPH
Podiatry has tried for so long to achieve parity with allopathic and osteopathic medicine and has continued to come up short. Ideally, revamping the APMLE exams to be independently evaluated and made comparable to USMLE would be my first hope in bringing that initiative of parity to fruition. However, short of achieving that goal, the combining of a PA and DPM degree is a worthy alternative route. Physician extenders are gaining more independence and the future points to more independent practice as a Physician Associate (PA). That combined with the DPM degree would be of real value - initially perhaps with an online alternative as proposed, and later as an integral part of the DPM curriculum whereby a podiatry student would obtain a PA degree after 24-30 months of their joint podiatry/PA education studies, and then a DPM degree after 48 months, and then onto residency
.
This would allow some to leave after receiving the PA degree while others can continue on to a DPM and if at any time wish to practice as a PA rather than a DPM, they have that option. It would also provide for more options for people who might choose at any time to stop practicing podiatry and have a viable option as a licensed PA. Frankly, I am surprised that optometrists (OD) have not gone that route as many of their colleges currently provide a PA degree already, i.e. Ketchum in California and Salus in Pennsylvania.
James DiResta, DPM, MPH, Newburyport, MA
03/10/2023
RESPONSES/COMMENTS (PM QUICK POLLS) - PART 1B
From: John Moglia, DPM, Jon Purdy, DPM
I agree with Dr. Udell, a PA degree will not make us a better podiatrist. The million dollar question is if the PA degree will allow better reimbursement from insurance companies who discriminate against podiatrists with lower reimbursements for the same services provided by an MD. It would also allow for a greater scope of practice in those states that limit podiatrists to the foot but not ankle.
John Moglia, DPM, Berkeley Hts. NJ
I’m not sure what the controversy would be in a podiatrist obtaining additional training or degrees. I see no negatives but a number of positives. In my state, PAs can see patients independently, even opening their own practices. For a podiatrist, this would mean being able to do their own H&P on their healthy patients, bypassing the need for shuffling to other providers. Even though orthopedics can do their own H&P, they often refer the pre-operative patient with comorbidities to primary care for clearance.
It’s really a travesty that we podiatrists cannot administer the simplest of injections if it isn’t in the foot, or in my state, even trim a fingernail. We would still need MD or DO oversight with the PA degree, but that is easily accomplished. We would no longer have to practice below anatomic structures for simple treatment of wounds, contusions, or sprains to name a few. If I had to venture a guess, an advanced degree would be seen as detrimental to the podiatric powers that be, who rely on contributions to drive the endless legislative fights. The advanced degree would negate that need.
Jon Purdy, DPM, New Iberia, LA
03/09/2023
RESPONSES/COMMENTS (PM QUICK POLLS)
From Elliot Udell, DPM
I am entering this discussion from a totally different perspective. For the last three years of my parents' lives, I was their caregiver. I drove behind many ambulances and often took them to urgent care facilities and plenty of doctors' offices. Combined with my being an allergy and breast cancer patient, I have had a lot of experiences with PAs. Some urgent care facilities are completely run by PAs and some hospital ERs are also run by PAs with a physician behind the scenes okaying whatever they do. What I have gleaned from these rough years is that some PAs are well-trained and have far more patience and good bedside manner than the MDs they work for. In other cases, the visit with the PA was a waste of time.
On Thanksgiving, I was in urgent care as a patient and the PA was honest with me. He had never worked with a patient with my symptoms and urged me to either go to the main ER or see my primary care doctor the next day. When my mom broke her pelvis, the PA at the hospital ER properly diagnosed it but the treatment plan she gave my mother bordered on negligence. We had to return to the ER the next day where we saw an MD certified in ER medicine. He addressed things properly and let us know that the PA mismanaged my mother's case. Should podiatrists aspire to become PAs? Will it make us better foot and ankle specialists? I doubt it.
Elliot Udell, DPM, Hicksville, NY
03/08/2023
RESPONSES/COMMENTS (PM QUICK POLLS) - PART1A
From: Daniel Chaskin, DPM, Rod Tomczak, DPM, MD, EdD
In the proposed scope of practice clean-up bill in New York State, most podiatrists would be prohibited from treating conditions such as melanoma in situ. Getting a PA degree would allow podiatrists to treat ankle conditions that the proposed state clean-up bill prohibits.
Daniel Chaskin, DPM, Flushing, NY
I have an MD degree I have used to open three medical schools around the world along with an EdD degree which was more important functionally than an MD degree. I have never used my degree to see a patient or even thought of practicing as an MD. I have recently been asked to open a PA school. PA schools require an MD to be the responsible administrator.
I have to inquire what would be the goal for anyone to become a DPM, PA? Will I have to take PA boards? Will I need a residency and what will the license allow me to do? Can I manage the type 2 diabetics I see for wound care or...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/16/2020
RESPONSES/COMMENTS (PM QUICK POLLS)
From: Dennis Shavelson, DPM
The complications that the COVID-19 virus creates when added to Dr. Markinson’s persistent warnings against my decades old choice to accept the dangers of grinding thick, ugly, dystrophic, and problematic toenails in practice has me raising the white flag and looking for a work-around solution.
Over the past two plus months, as my building in NYC was closed to traffic, I have acculturated to dispensing proper instruments to well selected patients (new income stream) along with mandating telepodiatry visits teaching them or an essential support person on how to perform maintenance of their toenails and calluses at home (new income stream).
I advise my colleagues to consider that adaptation in their practices as an alternative to other valid suggestions that have been made.
Dennis Shavelson, DPM, NY, NY
02/24/2020
RESPONSES/COMMENTS (PM QUICK POLLS) - PART 1B
From: David A. Pougatsch, DPM
Podiatrists are the experts in treating the lower extremity, and it is imperative that residents be on a committed service exposed to the wound care continuum, inpatient and outpatient. The resident follows from initial presentation, discussion of etiology/pathology, biomechanical evaluation, diagnostics, plans surgical and non-surgical treatments, and learns from the successes and failures; all of which will be instrumental in the resident’s professional development.
A dedicated wound care rotation not being a part of podiatrist’s residency program is akin to a trauma rotation withheld from an orthopedic surgeon’s residency. It’s just stupid and nonsensical. When podiatrists complete their training, there will be many who will have no interest in treating wounds; likewise with an orthopedic surgeon not treating fractures. However, our community needs to ensure that future podiatrists are well-equipped to treat any pathology. This foundation is cemented in a residency program that includes a wound care rotation. We have all worked tirelessly to evolve the residencies and fellowships into what they are now. Podiatry, and the medical world as a whole, would take a step backwards if a wound care rotation is not officially required during residency training.
David A. Pougatsch, DPM, Los Angeles, CA
02/15/2019
RESPONSES/COMMENTS (PM QUICK POLLS) - PART 1B
From: Don Peacock, DPM, MS
One of the most valuable examinations I use is Dr. Shavelson’s biomechanical exam and foot typing. if you've never had the opportunity to study his biomechanical exam, I would advise that you do so. The exam is not only amendable to orthotic fabrication but also vital in surgical evaluation.
I believe that our profession should not divide into sub-specialties. As podiatrists, we are already a sub-specialty. Most of our colleagues do some form of surgery, even if it's only a small part of their practice. Even if a podiatrist only does ingrown nails and warts and no bone surgery, s(he) is still doing surgery. A case could be made that ingrown nail surgery is one of the most risky things we do and requires surgical skill to properly manage.
I believe most podiatrists would rather choose to practice a combination of medical and surgical. I would define myself simply: I am a podiatrist.
Don Peacock, DPM MS, Whiteville, NC
10/18/2018
RESPONSES/COMMENTS (PM QUICK POLLS) - PART 1B
From: Carl Solomon, DPM
I think the discussion about our cutting fingernails has gotten a little out of hand. I can’t provide any legal advice because I’m not a lawyer, but the following is my personal common sense opinion. I believe it goes beyond the question of “Should podiatrists be allowed to trim fingernails?” The issues seem to be whether our license covers it, whether we can be sued if we cause some damage, and whether our professional liability insurance would cover us.
There’s a difference between our trimming fingernails as part of our professional license vs. trimming fingernails as a lay-person, which anybody is “allowed” to do. I can give someone a...
Editor's note: Dr. Solomon's extended-length letter can be read here.
12/14/2017
RESPONSES/COMMENTS (PM QUICK POLLS) - PART 1A
RE: Will eliminating the ACA mandate help podiatry? (Joel Lang, DPM)
From: Jerry Cohn, DPM
Dr. Lang makes a statement that is misleading. He states that the CBO determined that a certain number of patients will “lose” their insurance. The statement is misleading as the proposed change in law is to allow a person to unilaterally drop their insurance without fear of penalty. The penalty for not carrying insurance is to be removed, allowing people a choice. It is not changing determinant factors to obtain or keep insurance.
There is room for an argument to be made that there will be more people not carrying insurance and thus presenting to an office in a cash pay situation. How an individual physician handles this predicament is individualistic and would determine the gain or loss in income.
Jerry Cohn, DPM, Greenville, OH
04/01/2017
RESPONSES/COMMENTS (PM QUICK POLLS)
From: James R. Christina, DPM
During the emerging issues forum at the APMA House of Delegates meeting earlier this month, Immediate-Past President R. Daniel Davis, DPM, brought to the house a concern he has heard from some young physicians that “podiatrist” is no longer the primary term they use to identify themselves. Dr. Davis asked the delegates for their feedback about this concern, specifically as it relates to APMA’s name and brand. That conversation, while very constructive, has been taken somewhat out of context.
APMA is a 105-year-old organization with a rich history representing the profession. While it is critical that we accurately represent the professional identity of our members, changing our brand is not something we take lightly.
APMA is engaged in a brand audit. We’re collecting quantitative and qualitative data about perceptions of the organization, our products and services, and—yes—our name. We have engaged an outside consultant, McKinley Advisors, to assist us in this process. McKinley Advisors has expertise in organizational branding, specifically for association clients. Their President Jodie Slaughter is working directly with our staff team to assemble and analyze the data we collect and ultimately identify recommendations for enhancing APMA’s brand.
Until we complete that process, which is only appropriate for a national organization considering a change of this magnitude, we have no recommendation to change the name, much less a proposed new name for the organization. APMA looks forward to engaging with and receiving feedback from its membership as we work through this exciting process.
James R. Christina, DPM, Executive Director and CEO, Bethesda, MD
Editor's note: This topic is now temporarily closed.
12/05/2015
RESPONSES/COMMENTS (PM QUICK POLLS)
From: Paul Kesselman, DPM
I have read with great interest the polling results regarding PQRS penalties posted on this forum. The polled responses, I believe, are somewhat skewed to those individuals who were subjected to the penalties, simply because they either chose not to participate, attempted to perform this manually, or used a system which did not track or automatically bill the appropriate "G" codes when required. Certainly, the possibility exists that CMS also made errors. The system is fraught with not having sufficient numbers of trained support staff and the only way to get through is being persistent or calling at the crack of dawn. The appeals system appears to also be fraught with problems, and from those who attempted an appeal, it appears to be a nightmare with no positive results.
In speaking with those who use the same EHR in the same manner as I do (ICS Software - AKA Sammy), I have found no podiatrists who were subjected to the penalty. This silent majority using similar systems thus has...
Editor's note: Dr. Kesselman's extended-length letter can be read here
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