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02/17/2015
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Stephen Musser, DPM
Is it me, or is anyone else surprised that over 60% of podiatric offices do NOT schedule an annual CDFE for their diabetic patients? Who else better than podiatrists to perform this type of examine? I'm curious as to how many ophthalmologist offices schedule an annual eye exam for their diabetic patients.
Stephen Musser, DPM, Cleveland, OH
Other messages in this thread:
12/30/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Kevin C. McDonald, DPM
I read with interest with results of the poll on the biggest threat to our profession. I don’t feel that advanced practice nurses and orthopedic surgeons are threats at all, compared to the lack of applicants to podiatric medical school.
There are no easy answers to this problem but I would like to see a university-affiliated podiatry school develop a six-year program to become a podiatrist after graduating high school. The medical education (and clinic time) could begin in the second year of the program. Additional components could be a) work-study programs for podiatry students as medical assistants in podiatry offices and b) the development of a “Diabetic Foot Center of Excellence” at the school to specialize in great care for diabetic feet and to perform research supporting and proving that podiatry care is a valuable and cost-efficient part of the care of people with diabetes.
The purpose of this program would be to a) increase the length of time for podiatric medical education and b) lower the net financial and time costs of becoming a podiatrist. Letter writers to PM News often advocate for national PR and advertising programs to enhance our status, but I feel that money spent on research proving the value of our work would be a better investment on a national basis.
Kevin C. McDonald, DPM, Concord, NC
10/31/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Paul Kesselman, DPM
Each state has or does not have licensing laws pertaining to the regulation of certain services. Orthotics and prosthetics are no different. Providing custom fabricated, custom fitted or over-the-counter orthotics are prime examples where state regulations not only differ but often completely clash.
One example, here in NY where just about everything is highly regulated, one may scratch their head when they find out that there are no state licensing requirements for providing custom orthotics or prosthetics. This means anyone can hang a shingle out and sell custom orthotics and prosthetics. No formal schooling, training or certification, or license required. Across the Hudson River, you cannot provide custom orthotics or prosthetics without having either a...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/28/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Kathleen Neuhoff, DPM
I think that a class action suit to prevent distribution of orthotics is ludicrous. We voluntarily gave up the fabrication of orthotics. When I first started practice, nearly every podiatrist cast for orthotics and most made them on their premises. Now, I am the only local practice which makes our own orthotics in my office and, from my work with podiatric residents, very few know how to cast (with ANY method). There is a huge need for orthotics and if there is a void in fulfilling this need, someone will step in to fill the void. We cannot expect to have our cake and eat it too!
Kathleen Neuhoff, DPM, South Bend, IN
10/25/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Irv Luftig, DPM
I graduated from OCPM in 1980 with Greg and practiced near the Toronto area for over 40 years until I retired in 2002. My practice was a successful one with thousands of loyal patients, standing out from almost all of the others within a 50 mile radius using the same mantra as Greg's. Proper biomechanical exam, non-weight-bearing plaster casting of each and every orthotic patient whether they were 8 years old or 80 years old. I was lucky enough to have a 3 year residency, surgically trained (with fellowship) podiatrist come up from the U.S. to take over my practice when I retired. He practiced in the U.S. for 5 years before coming up here to settle.
It took a full year of hammering away at the importance of biomechanics as an adjunct to all his surgical training. It took awhile but it sunk in. He had virtually no training in biomechanics. I was shocked but was relentless, teaching and mentoring about the principles of gait analysis, a thorough biomechanical exam, and...
Editor's note: Dr. Luftig's extended-length letter can be read here.
10/25/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Paul Slowik, DPM
I read Dr. Caringi’s letter with a bit of sad remorse. Biomechanics was a very important aspect of the DPMs’ training “back in the day”. Like Dr Caringi, I also performed a biomedical exam, gait analysis, and did plaster of Paris impressions. For the most part, all of my orthotics were custom made, meaning I listened to the patient and made individual adjustments. Rarely, no two devices were identical. Sometimes I had to make adjustments over and over again until I got it just right.
The patient had a true prescription which could be the basis for further devices. One size fits all is a travesty to our profession. Patients with severe deformities need those to function. Not all patients are surgical candidates. Patients would gladly pay several hundred dollars if you could make a device that really works.
And by the way, at least in California, orthotics are not considered a real prescription hence a class action suit would be fruitless.
Paul Slowik, DPM, Makawao, Maui, HI
10/25/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A
From: William Beaton, DPM
I wish to second all of the comments made by Dr. Caringi. From the time I graduated from podiatry school to this day, I have always had an in-office laboratory where I have made orthotics dating back to leather and cork through Rohadur, Polydor, and now finally Carbonfiber.
Yes, we have lost that aspect of our practice to the OTCs, pre-fabs, and yes even some of the laboratory produced accommodative orthotics. It is a shame that podiatrists don't control the true biomechanical physician crafted corrective orthotics market.
William Beaton, DPM, Saint Petersburg, FL
10/24/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Greg Caringi, DPM
After closely following PM News for many years, I know my commentary is not new and unfortunately reflects the feelings of many podiatrists who are now at/near retirement age. These thoughts have been woven into many previous threads.
Many say that the early growth of podiatry was because our profession filled patient needs not being adequately addressed by other medical and surgical specialties. When podiatry was still struggling for recognition and parity, we were all encouraged to learn and use those skills to make us stand out as specialists who could offer options that were not readily available from other medical specialists, such as...
Editor's note: Dr. Carigni's extended-length letter can be read here.
07/26/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Kenneth Meisler, DPM
After 35 years of practice, I made the decision to charge patients who do not cancel at least 24 hours in advance. The fee has gradually risen over the past 10 years from $40 to $75. I wish I had done it 25 years earlier. This was never done to get income for the missed appointments; it was always to try to get patients not to cancel last minute. Every new patient receives and signs a form stating our cancellation policy at the same time as they fill out their new patient intake forms. 99% of patients sign the cancellation forms. When patients call to cancel the same day, we remind them of the cancellation policy and about 1/3 of the patients say "OK, I'll make it." That alone makes the policy worthwhile.
Unfortunately, we also get people who just don't show up for their appointment and don't call. We call those patients and depending on their reason for not showing and not calling, we frequently forgive the first time. If a patient has a history of no-shows, we will not let them schedule another appointment until the $75 no-show fee for the last visit has been paid rather than let them pay it at the time of their first visit.
I tell patients we instituted this rather than overbook to make up for cancellations. I also think that most patients respect you for it and frequently patients say, "I'm fine paying it. I realize it was my fault." We receive thousands of dollars in "no-show" payments a year.
Kenneth Meisler, DPM, NY, NY
07/03/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Wenjay Sung, DPM, Joel Feder, DPM
Congrats on the name change and new logo, but what color blind agency came up with this color by committee scheme? It’s like if old podiatrists asked AI “what colors do young people like?” but vomit green and puke yellow were already taken. But congrats on the name change.
Wenjay Sung, DPM, Arcadia, CA
I agree with Dr. Steinberg's Congratulation on the change of the "Illinois Podiatric Medical Association" to the "ILAPPS". But why is the logo missing the "Winged Foot" on the caduceus? And in keeping with modern medicine, it should really be "The Staff of Aesculapius with a Foot".
Joel Feder, DPM (Retired), Sarasota, FL
07/02/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Robert Scott Steinberg, DPM
I am shocked that more 50% of respondents think "podiatrist" is a good enough descriptor. I wonder what their average age is. Were the respondent DPMs from the U.S. or podiatrists from other parts of the world?
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ILAPPS logo |
In January, the Illinois Podiatric Medical Association began doing business as the Illinois Association of Podiatric Physicians and Surgeons (ILAPPS), and with it, we adopted a beautiful new logo.
Robert Scott Steinberg, DPM, Schaumburg, IL
05/03/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Ivar E. Roth, DPM, MPH
I read Dr. Kesselman’s response. While I understand his thinking, here are my old school thoughts concerning student loans. Any student can easily reduce their loan dependence by working part time during their schooling or on summer breaks. Also decreasing debt is easy; spend less and scrimp during school and residency. Too many students today think nothing of drinking $6 Starbucks whenever they want and living above their means. Maybe you must reduce rent by sharing an apartment.
There are lots of ways to spend less and or supplement your income. There is nothing wrong with a little struggle but today’s students to me seem to be entitled to a certain lifestyle that maybe they can’t afford. What I am trying to say is that where there is a will there is a way. The same goes for wanting to just get a 9 to 5 job. If you want to really excel, try the concierge/ direct pay model, and make as much as you feel you deserve. Yes, it will be difficult at first but in the long run, you are the boss of your future not just an employee happy to get yourself a cost of living increase each year.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/02/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Paul Kesselman, DPM
Recently, I met a young intern doing his PGY-1 prior to starting his five-year residency in general surgery. He is faced with almost $400K in debt from medical school and more from undergraduate school. Between the two, he can easily amass $600K or more in debt. A neighbor graduating from high school will amass $500K in debt from his undergraduate degree and then more from his anticipated pursuit of a legal degree.
It is no wonder that more and more young students are moving away from traditional degrees in healthcare and moving to shorter degree paths with easier career paths. PA and NP are far shorter than MD/DO and DPM degrees with much less stress, easier lifestyles, and nice salaries. Nurse anesthestists command $150+ salaries after a four year BSN and a year or two of...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/02/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A
From: Shashank Srivastava, DPM
I understand the points that Dr. Hofacker is making and all are very good. That said, I personally feel that it is not reasonable to expect 17 year old high school kids to want to know they want to be podiatric surgeons at such a young age. I remember how I was at that age, and no way could I have made such a commitment. I think a certain level of maturity and some life experiences are required before making this commitment.
The problem is if they decide at 22 years of age that they want to do something different (common sentiment among that age group), there is no turning back and lots of debt and possible resentment. Unlike allopathic or osteopathic physicians, we cannot just simply change specialties and do different residencies and fellowships. There is no turning the ship around.
Shashank Srivastava, DPM, Rockville, MD
05/01/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Rich Hofacker, DPM
I was surprised when I read that only about 1/3 of our profession is in favor of a 6 year college/podiatry school option. In an ideal world, a 4 year undergraduate degree, a 4 year podiatry degree, followed by a 3 year residency would still be preferred. However, it is not an ideal world any longer. The enrollment in our podiatry colleges is down, which means the selection pool for good candidates is not good and some of the schools may have to consider closure, if the current situation does not reverse itself.
I have 4 children, all of whom had the bedside manner and the work ethics to become outstanding physicians. However, they all chose different career paths, which is more than fine, but it is the reasoning behind their decisions which still bothers me. The two main reasons that they told me for not considering medicine/podiatry were the cost and the amount of extra years of schooling.
I think that we need to still investigate the 6-year college/podiatry school option. We may be losing some good potential students to carry on in our noble profession.
Rich Hofacker, DPM, Akron, OH
03/26/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Steven Finer, DPM
This week’s poll covers disability insurance. As to new practitioners, when you buy this product make sure you understand the meaning of disability. For example, some policies may state that should you have a life-threatening situation, you could still teach and therefore be denied coverage. The policy should state that upon the fact of not being well with a serious medical condition, you will collect. Years ago, I bought the wrong policy, and a few years later turned that in and bought one with the proper definition.
Steven Finer, DPM, Philadelphia, PA
03/19/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Kristin Happel
Once again, I am astonished and disheartened by the lack of preparedness on the part of providers to deal with a crisis involving their income. Did anyone not learn anything from the COVID shutdown in 2020? As a rule of thumb, each practice should have 3 months or more of income set aside in order to deal with any adversity that may befall a practice...such as a pandemic, or a cyberattack on their clearinghouse, or anything else that can be imagined. This is the same financial advice given to anyone who has a job they count on to pay their living expenses. I have 3 or more months of income in savings. I know I do, and I am not a doctor.
I know the running "joke" is doctors make the worst business owners, but this is ridiculous, in my opinion. If you own a practice, you better make sure you are a good business owner, or you don't have any business owning a practice. I have been reading in the news recently that various practices are going to have to close down/let staff go, because of the...
Editor's note: Ms. Happel's extended-length letter can be read here.
02/28/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Pete Harvey, DPM
I was somewhat taken aback to read that almost half of the profession is paying over $450/month for EHR services. In every journal I read, at every meeting I go to, and in personal correspondence, this topic is never discussed. It might be interesting to begin a discussion concerning the various ramifications of EHR cost and implementations.
Have any readers been through the process of your program being sold without your knowledge until you get a call or email stating that your program has been sold to another EHR provider? Then, you must continue with the new provider or find a different one. This topic, and those related to it, should be on every podiatry program in the country. We might begin here. If you discuss a particular EMR provider, it’s probably best to delete the name.
Pete Harvey, DPM, Wichita Falls, TX
07/28/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Joe Agostinelli, DPM
The question asked about emeritus status for certifying boards is not a yes/no/unsure type choice. I retired from practice in 2017, which coincidentally was my year point to recertification for ABFAS. I was board certified in 1987 went through the certification process every 10 years. I contacted the board and told them I was retiring from practice and received a letter from the ABFAS stating I had “retired” status with the board.
If I ever wanted to return to practice and activate my board certification, I was told I would have to take the required CME, complete the recertification process, and pay the annual fee. This seemed appropriate to me. Emeritus status makes sense for the fellowship status of ACFAS, AAPSM, and ACPM but should NOT be offered by the certifying boards. Emeritus status, in my opinion, for the certifying boards is misleading to the public, especially as to someone years from retired practice. It doesn’t have anything to do with the years of paying registration fees for maintaining board certification status. The certifying boards have processes in place for regaining active board certification status and have a “retired “category for those fully retired from active practice.
Joe Agostinelli, DPM, Niceville, FL
06/20/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Don Steinfeld, DPM
I answered last week’s question of what the greatest existential threat to podiatry is with ‘other’. My feeling, as an ‘85 graduate, is that a lack of unity among us is the key. No obstacle, including the insurance industry and the government, is insurmountable IF we act as one. Together we could wield a mighty sword.
We surely can all find reasons to complain about our leadership. But it’s our leadership. How terrible the lack of involvement of young practitioners is! Don’t miss the forest for the trees. Our profession has made spectacular progress. The APMA is our voice and our sword. My late father-in-law was a factor in optometry’s success in expanding their status and privileges versus opthalmologic opposition. This has benefited my wife who followed him in practice. How did he do it? Leadership. Organization.
Don Steinfeld, DPM, Farmingdale, NJ
06/15/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Richard M. Maleski, DPM, RPh
In my opinion, the biggest threat to podiatry is the fact that we are still not considered physicians in all senses of the word. All of the other issues with intramural bickering, insurance problems, etc. are not specific to podiatry. All medical disciplines face these issues, and they all fight each other and many "eat their young," not just podiatry. But until we can be recognized as physicians legally, we will never be able to fully participate in all aspects of the healthcare industry.
I don't know how we achieve that, whether it be a degree change along with the appropriate changes in our education, or a change in the way our post-graduate education is currently structured. Although many, if not most of us, are considered true "doctors" by our patients and MD/DO colleagues in our communities individually, we must be able to be legally classified as equals as an entire profession before we can expect to be reimbursed equally or be in positions of leadership as other physicians are. I think that this is also the main reason we are not attracting more young people to our schools.
Richard M. Maleski, DPM, RPh, Pittsburgh, PA
06/14/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Patrick J. Nunan, DPM, Steven Kravitz, DPM
I find it interesting that a person commenting that the profession itself is its own biggest threat, once testified against ankle privileges for podiatrists on behalf of orthopedic surgeons in his state. At that time, I was vice president of that state association and heard his testimony firsthand. Was not the question asking for forces outside of the profession?
Patrick J. Nunan, DPM, Beaufort, SC
Dr. Tomczak points to an age old question that faces not just podiatry, but all fields of medicine. There's too often a disconnect between the pride of being in medical practice, the economics that drive that practice, and the realization that all of us have a limitation of education. At the end of the day the primary focus must be whatever is best for the patient.
I just had a paper accepted by The Journal of Wound Care (due October 2023) that addresses this very issue. It describes a simple vascular procedure that went wrong, causing...
Editor's note: Dr. Kravitz's extended-length letter can be read here.
06/14/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A
From: William A. Wood, DPM, MPH, Robert Kornfeld, DPM
The greatest existential threat to our profession is the lack of a national practice act license uniting the profession.
William A. Wood, DPM, MPH (retired), Chicago, IL
Other than the fact that podiatry has never been a cohesive unit, I believe the biggest existential threat is participating with health insurance. There will be no end to the erosion of income over time. Podiatrists work like dogs and are being exploited by insurance companies. So who is to blame? Clearly, insurance companies because they figuratively rape doctors. BUT, this is not a new story. It is the continued participation/cooperation/acceptance of this madness that is also to blame. And that is something every podiatrist can change. Otherwise, they can continue working as the underpaid employees of the insurance companies that they are.
Robert Kornfeld, DPM, NY, NY
06/13/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Rod Tomczak, DPM, MD, EdD
The biggest existential threat to podiatry? For the last 50 years, we ourselves have been the biggest threat to the profession. I remember being in school in the early 1970s hearing the statement, "Podiatry eats its young."
It seems like there is always an intra-podiatry conflict of some kind. More often than not, the strife revolves around surgery, board certification, and extent of privileges. We, of vintage age, remember the intra-podiatry lawsuit; one group of podiatrists suing another group of podiatrists. Then there was the formation of PPOs, and podiatrists were literally paid per capita to essentially do nothing for patients. To become a member of the PPO a podiatrist paid $10,000 to someone and then...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/01/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Gary Mantell, MS, DPM
I have been following the discussion of the various medications that are being used by some in their office for pre-operative sedation. I fondly remember discussing the selection of drugs for use in office cases with the chief of anesthesia at NYC’s St. Barnabas Hospital while I was a resident there in 1984. At the time, an entire issue of Clinics in Plastic Surgery was devoted to office-based surgery since plastic surgeons, like podiatrists, were among the pioneers in the field. One article, “The Selection of Drugs in Office Surgery” discussed the use of the various classes of drugs in the office setting.
I asked the question of him, if he were going to operate in an office, what would be the one thing he would use. His pithy answer was that the one thing he would use would be an anesthesiologist. He punctuated his advice by informing me that if you put it in, you had better be able to take it out. To this day, if my patient is overly anxious or fearful and might need pharmacologic assistance, they go to the surgery center. The results of the reader poll showing over 70% of podiatrists steering clear of in-office sedation appears to be consistent with that decades old advice. I have no desire to manage a potential adrenergic response to anxiety, fear, pain, or hyperstimulation.
Gary Mantell, MS, DPM, Memphis, TN
05/29/2023
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Narmo Ortiz, DPM
While I cannot imagine that any practicing colleague would be against a uniform scope of practice law for podiatrists, first and foremost what needs to be achieved is national licensing uniformity and/or reciprocity for podiatrists to be able to practice in any state he or she chooses to call home.
Narmo Ortiz, DPM, Davenport, FL
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