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05/08/2015
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
RE: EPAT
From: John Moglia, DPM
I would like to add to the ESWT discussion. EPAT is a less expensive alternative To ESWT. While it may take up to 6 treatments to be effective, I have seen dramatic improvement and "cures" in many recalcitrant cases (over 6 months ) treated elsewhere with conventional therapy. I put "cures" in quotation marks as there is no cure for those patients who return to the repetitive stess of running or an occupation that causes re-injury. Patients are willing to pay a reasonable fee as an alternative to surgical treatment or painful cortisone injections, with no guarantee of "cure" either. I have no financial interest in an EPAT company and won't even mention the name of the company I use.
John Moglia, DPM, Berkeley Hts, NJ
Other messages in this thread:
01/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ivar E. Roth DPM, MPH
Based on the recent concerns about attracting students and making a living, I would like to throw a life raft out to the future podiatrists and the current ones as well. To be successful as a concierge podiatrist, I have had to offer services that no one else offers or services that many might think is below them.
Let me start off by saying I offer medical pedicures. I consider myself an expert in the old world of performing C&C. We get approximately 2 to 3 new patients every day. While we charge cash, and the fee is rather low, we offer a very needed service that people want and need. A certain percentage of these patients need and will pay out-of-pocket for other services, most commonly orthotics and fungus nail treatments.
Ivar E. Roth DPM, MPH, Newport Beach, CA
01/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Ten or twelve years ago, the television was inundated with commercials for Laser Spine Surgery Institutes or similar organizations. One of the entrepreneurs wanted to establish a program in Belize as a medical tourist destination center. It was short lived. Malpractice claims in the U.S. skyrocketed. The surgery was performed endoscopically and any doctor who wanted to be trained and work for the company could. Patients showed up with $30,000 or so in hand to turn over to the company because no insurance was accepted. Since radiculopathies and painful feet along with foot drop affect patients, we can assume California podiatrists could have been trained to perform the procedure. Unfortunately, non-spinal surgeons were not trained to address the surgical complications resulting in deaths and paralysis. They make intra-operative neurophysiologic monitors to alert board certified neurosurgeons of impending disaster. But a weekend course should obviate the need for that. There is at least a day’s worth of reading concerning the topic on the Internet.
Dr. Roth, I would not feel very comfortable performing a stent placement in the Fem-Pop area of the leg because you and your podiatry friends think it’s OK. You cannot possibly believe that you folks define and interpret the law. The opinion of the CPMA attorney makes it legal? It is an opinion. You know that old saying, “opinions are like mouths; everyone has one.” If the California Supreme Court felt stent placement was within the legislated definition of podiatry in California, that may be another thing. Stent placements have been known to go wrong and the vessel ruptured. Are you and your DPM friends prepared to perform a Fem-Pop arterial repair, anastomosis, or insert a new surgical graft? I realize you have not had to address many complications, but there are surgeons who have.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
11/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Allen M. Jacobs, DPM
Dr. Roth expresses his "disgust" at the treatment of plantar fasciitis by a colleague. He opines that the "younger podiatrists" are motivated by money rather than patient well-being. He states that the patient consulted with an insurance covered podiatrist rather than "me", (that is) Dr. Roth. What was most disconcerting to me was the statement that Dr. Roth reviews anything for the purpose of making a judgment on the necessity of care and, hopefully not, standard of care.
Dr. Roth is critical of the utilization of ECSWT for the treatment of plantar fasciitis. In point of fact, while I personally do not employ ECSWT due to the general difficulty in obtaining insurance coverage for this modality, it is an acceptable and not-infrequently utilized modality for the management of plantar fasciitis. There is reasonable literature support for this modality in the management of...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
10/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Howard Bonenberger, DPM
Everything is related to the perceived value brought to the table. In their minds, a degree which is universally recognized by the public, VC firms, or other businesses, the MD (DO) can author research on the entire body. The DPM has limited scope which can be covered by orthopedic research, at least in their minds.
Perhaps submit research that is blind as to the authors' names and degrees. It would not be for actual publication but to have it read by someone who is curious. If of high enough quality and the publication inquired, then it would be revealed that the author(s) were DPMs. I may be way off base, I'd appreciate thoughts on this idea.
Howard Bonenberger, DPM (Retired), Nashua, NH
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Lawrence Rubin, DPM
A recent post in PM News pertaining to insurance reimbursement compliance said, "Any abnormal findings on the LEAP Vitals Exam, i.e. dry and xerotic skin (L85.3) caused by sudomotor dysfunction, is a significant risk to a patient with diabetes. It therefore warrants a care plan." To prevent confusion of business names, this is not a stated opinion of the 501(c)3 not-for-profit LEAP Alliance.
Lawrence Rubin, DPM, Las Vegas, NV
10/05/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Irv Luftig, DPM
Although it may be a good thought to unionize physicians, podiatrists, dentists, etc., it's a really bad idea. It was a tactic used by various medical groups a few times up in Canada and each time ended quickly as a miserable failure. There was absolutely zero support from the general public. There was palpable outrage from the public. Simply put, doctors (MDs, DOs, DPMs, DDS’) are perceived as wealthy because "we all make hundreds of thousands of dollars."
The public doesn't care about overhead, salaries, etc. Most people make $50,000 or less, maybe a bit more. You will be viewed as greedy, wealthy, uncaring, and if you withhold services in a strike, then watch out for the swift reaction from politicians and the public. Politicians will make mince meat out of you and the public will hate you. It won't be pretty and you will potentially be losing your patients' trust for years.
Irv Luftig, DPM (retired), Toronto, Ontario, Canada
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jon Purdy, DPM
Regarding the post from Dr. Tomczak, I did find that very amusing. I don’t intend to do a back and forth on this, but suffice it to say, I never put someone’s name in print without their permission. I’m sure that person would have been fine with it had I asked.
All associations post-covid have struggled, which necessitated change. As treasurer of the American Academy of Podiatric Practice Management, there has been change required of our own organization. We welcome constructive criticism, as it helps us improve and grow. It’s no different for the APMA. Time will tell, but I like the vibe they are currently putting out, and its leaders seem to be in tune with positive change.
Jon Purdy, DPM, New Iberia, LA
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ron Werter, DPM
What I don’t understand (and maybe the lawyers among us could explain) is how does the insurance company have the legal right to charge the doctor for writing a prescription. The doctor has no financial stake in the prescription; the patient and the pharmacy are the ones who have financial benefit. Is there something in an insurance company contract that says they can do that?
Ron Werter, DPM, NY, NY
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Kathleen Neuhoff, DPM
Sadly, I must agree with Dr. Doms. I was president of the American Animal Hospital Association years ago and we investigated the cost of such a campaign. It was many millions of dollars. At that time, there were about 50,000 veterinarians. It would have required a donation of more than $500 each if EVERY veterinarian contributed. We polled our members and the average they were willing to contribute was $100. And we knew from PAC contribution records that less than 10 percent would actually contribute, so it was not feasible.
The advertising we have been able to do has been primarily supported by our vendors but I suspect the amount of money spent by clients for products such as pet foods, cat litter, flea products, etc. far exceeds the amounts spent by our patients for podiatric-related products. It is certainly possible that some of the podiatrists reading this would be happy to contribute $1,000 each year for a PR campaign, but I suspect most would not.
Kathleen Neuhoff, DPM, South Bend, IN
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Howard Bonenberger, DPM
I cannot agree more with Dr. Jacob's letter. I feel secondary embarrassment when reading a post, presumably from social media or print material, quoting a podiatrist about foot odor, Dante's flip-flop hell, shoe selection, and ingrown nails.
I experienced something that may be partially at fault: years ago a local writer asked for an interview. She came with a list of questions which would have produced the very subject matter we are denigrating. I realized that she knew little about our training and skill level. I walked her through a typical week of sports injuries, fracture care, office and hospital surgeries, diabetic care, and C & C. She was a little embarrassed and very grateful for the eye-opening education. She actually became a patient and referred many others over the years.
I suggest that when asked to be interviewed for an article, podiatrists provide a thoughtful, short summary of a typical week and educate the interviewer. Plan ahead, please use spell check and proper grammar. Send them to various health news outlets. I have never read an interview with an orthopedic foot and ankle doctor who is discussing buying junior's shoes. It is because the interviewer would never deem to insult them with such lowly questions, after all...they are seen as well-trained physicians and surgeons. Until we, as a profession, set the table of expectations, not much will change.
Howard Bonenberger, DPM (Retired), Hollis, NH
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jerry Peterson, DPM
No, you are not missing something. He should be able to assist ANY physician on ANY surgery. In Oregon, a podiatric physician can assist in general surgical procedures, Ortho, Neuro procedures, etc. They are not required to have the privileges to be able to assist. Good luck moving forward.
Jerry Peterson, DPM, West Lynn, OR
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Bret Ribotsky, DPM, Lawrence A. Santi, DPM
I’m eagerly awaiting APMA’s response to this issue before I send my check. Please choose wisely.
Bret Ribotsky, DPM, Fort Lauderdale,, FL
APMA values every member and their input, and we apologize to any life member who may feel disenfranchised by the current referendum. As background, eligibility to vote in a referendum is codified in the APMA Bylaws for each member category—the APMA Board of Trustees and staff cannot simply choose to allow life members to vote. The Bylaws, Procedures, and Rules Committee reviewed the privileges afforded each member category as part of its comprehensive review of APMA’s governance documents and included the current privileges that were adopted by the 2019 House of Delegates. Life members are not the only category of members who are ineligible to vote. For more information on eligibility, check out our FAQs about the referendum at www.apma.org/referendum.
The philosophy of the committee has been that members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum. So, life members, who are retired from practice, would not be affected by language designed to support scope of practice modernization.
I have heard your concerns, and the Bylaws, Procedures, and Rules Committee will consider the feedback we have received from life members at its fall meeting. To be clear, changing the bylaws would require action by the APMA House of Delegates, so any changes will take time. I thank you in advance for your patience and understanding.
Lawrence A. Santi, DPM, President, APMA
Editor's note: This topic is now closed.
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Stephen Musser, DPM
I disagree with your daughter's school decision. If the state where her school is located includes podiatry in the definition as a physician, then I think you or your daughter can argue/refute the administration's decision. I once had an MD/DO point out to me that I shouldn't be parking in a physician designated parking spot. I politely told him I am considered a physician in the eyes of the Ohio medical board and left my car where I parked it. Nothing came of it and nothing more was said.
Stephen Musser, DPM, Cleveland, OH
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Hal Ornstein, DPM
I highly recommend Mike Crosby, CPA of Provider Resources as a practice appraisal expert. He has performed this service for hundreds of podiatry practices and been doing this for many years. He is responsive, knowledgeable, and fair to all parties involved.
Hal Ornstein, DPM, Howell, NJ
05/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Greg Amarantos, DPM
I find it interesting how a post can be interpreted from a different lens and diametrically opposing conclusions are reached. In reading Dr. Tomczak's response to Dr. Roth, I read Dr. Roth's post differently.
While we should believe we are providing the best possible care, we have to face the facts; in private practice, our treatment protocols are at least partially driven by the insurance company policies. I do not read any impugning of the profession. Dr. Roth should believe he is providing the best care, as should you and I. Cash frees the practitioner from the shackles of the insurance company policies. Think of the man hours used on "meaningless use/MIPS" and the like. Dr. Roth reminds me that medicine made a deal with the devil years ago and...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jeff Root
You might want to consider using Quicken Classic Business and Personal if your accounting needs are fairly basic as you suggest. I believe the annual subscription fee is around $120 and costs about half that for the first year. You can set up custom income and expense categories and run income and expense reports that should satisfy your basic accounting needs. You might even be able to import some of your historical data from Quickbooks but you should check with Quicken or Quickbooks support about that first. I have been using Quicken for my personal accounting needs since the 1980s and used Quickbooks for business purposes for many years. I have been very satisfied with Quicken and they have excellent customer support.
Jeff Root, President, KevinRoot Medical
03/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Connie Lee Bills, DPM
We started this about a month ago. Patients are more likely to pay cash or check when faced with a 3.5% fee. My optometrist started it about two months ago and spurred me to follow suit.
I checked with the local credit union and they said HSA cards can be used for the fees as long as they are from a healthcare registered facility. Everyone should be doing this.
Connie Lee Bills, DPM, Mount Pleasant, MI
03/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Robert Scott Steinberg, DPM
"A significant portion of the older podiatric profession are the notional progeny of chiropodists. For many of us, the first exposure to our future profession was afforded by individuals with the letters DSC behind their names." - Tomczak
I highly doubt your statement to be true. Where did you get your statistics? I do not believe there are many 80+ year-old practicing DPMs in any leadership roles in their state or the APMA. If there were, things would not be so messed up!
Robert Scott Steinberg, DPM, Schaumburg, IL
11/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Alan Bass, DPM
I recommend Mike Crosby with Provider Resources. Mike is a CPA and has been in and around podiatry for as long as I can remember. I know that he has helped dozens of our colleagues value their practices in preparation for sale. He also works with DPMs to decide when it’s time to bring on an associate, or value the practice if moving an associate to partnership.
Alan Bass, DPM, Manalapan, NJ
11/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Richard M. Cowin, DPM
For a practice valuation, I highly recommend Mr. David Price at Podiatry Broker. He offers three (3) levels of service for three (3) different prices: $395.00 for a ballpark evaluation, $995 for an off-site evaluation, and $3,995 for an on-site evaluation.
Richard M. Cowin, DPM, Orlando. FL
09/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell, DPM
Dr. Bardfeld and I go back to the good old days when doctors were independent and we were paid well for our services. We charged patients and no one had druthers about writing us a check for our services. Today all doctors are at the mercy of insurance companies and hospital or corporate owned practices. Two GI doctors I know as well as a prominent cardiologist opted for early retirement after their practices were taken over by a hospital. The hospital had no difficulty however in filling those spots with young guys finishing their fellowships.
What needs to be done is to assess whether young doctors working in and out of hospitals or for corporate entities are happy with their lives as it stands in 2023. If they are happy, then unionization is a pipe dream. On the other hand, if most doctors, especially young ones, are not happy with the way things are going, then there may be room for organized protest in some form or actual unionization.
Elliot Udell, DPM, Hicksville, NY
09/14/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Kathleen Neuhoff, DPM
When I chose to go to podiatry school in 1990, it was partly because the diversity of care that we offered was very appealing. I knew that, thanks to the efforts of previous podiatric pioneers, I would be able to obtain surgical privileges at a hospital to perform procedures such as tarsal tunnel releases and Haglund’s ostectomies which required general anesthesia. I also would be able to perform surgeries such as MIS exostectomies, bunionectomies, and nail procedures in my office. I knew I would also be able to do sports medicine and orthotics, pediatric care such as casting for metatarsus adductus, wound care, diabetic foot care, and “routine nail care”.
I continue to do all of these things. I still make orthotics in our office, have a surgery room with fluoroscopy, power equipment, and cryosurgery. Also, I have added laser therapy and shock wave therapy. I LOVE my podiatric practice and have certainly been rewarded very well financially and with...
Editor's note: Dr. Neuhoff's extended-length letter can be read here.
08/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jeff Kittay, DPM
I am a 1979 NYCPM alumnus, eight years out from practice, and remain a regular reader of PM News. How disappointing it remains to read the same complaints about unfair/limited/denial of payments to duly licensed well-trained professionals, that existed during my 40 years as a student and in practice. The insurers use the same language and excuses they have for decades in denying legitimate claims and/or reducing procedure payments when E/M codes are billed simultaneously, though for an unrelated diagnosis. I see that essentially nothing has changed since I left practice in 2015, which reinforces my decision to leave as the best one for me. The insurers have won the game, set, and match, and there’s nothing any of us can do about it. When the powers that be decided NOT to change the degree from DPM to MD, with all the attendant rigamarole that that would have entailed, podiatry’s fate was sealed.
For those who remain in practice, I can only wish you well, but the cards are stacked against you. I paraphrase Dr. Kass when I state the obvious, there are only so many hours in your day, so many patients you can see and safely treat, and still retain your health, sanity, and family life.
Jeff Kittay, DPM (retired), Pacuarito, Costa Rica
08/09/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Martin M Pressman, DPM
My friend and classmate Allen Jacobs, DPM is rarely wrong and has contributed positively to my 47 year career in numerous ways. His pleas to the profession to be more comprehensive with our evaluation and management of our diabetic patients are a series of benign micro aggressions that I believe moved the bar higher and will prove to be clinically important modalities to reduce amputation rates in diabetic patients.
I would add to his neurological recommendations that every podiatrist learn to utilize an 8 megahertz Doppler to LISTEN to the 3 runoff vessels to the foot plus the popliteal artery. This screening exam will find evidence of PAD with the finding of monophasic sounds in these arteries. We should use the Doppler like a cardiologist uses the stethoscope. Sending these patients for LE arterial ultrasounds will give the referring podiatrist pertinent information with respect to stenosis and oftentimes belies the notion that pulse palpability equals adequate blood flow.
If you document a “plus 1” palpable pulse, you are documenting an abnormality that requires further work-up, you are not documenting adequate flow. Thank you, Dr. Jacobs for your 5 decade efforts to educate our beloved profession.
Martin M Pressman, DPM, Summerville, SC
07/26/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Robert Scott Steinberg, DPM
The Midwest Podiatry Conference (MPC) used to have huge attendance, but no more. The conference is held in downtown Chicago, where the cost of everything is sky-high. It's a killer for exhibitors.
The MPC needs to poll past attendees.
• Is downtown Chicago the draw?
• Do attendees make it a family vacation?
• Would the conference be more attractive for attendees and exhibitors if moved to the suburbs where costs would plummet?
Robert Scott Steinberg, DPM, Schaumburg, IL
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