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10/05/2015
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Don Peacock, DPM
The ABFAS is a certifying board that has specific requirements for certification, and these rules are clearly outlined on their website. As an ABFAS diplomate, I know firsthand of the process. It is tough and rewardingly enjoyable. I had lots of cases to submit and the candidate can submit the cases he chooses to submit in accordance with the guidelines. From this list, 10 are chosen for further review. The guidelines are very clearly spelled out, and the ABFAS has loads of info to help the candidate submit cases properly.
Your complaints are unfounded and untrue. You have PSR24+ training and meet all requirements for certification. So what you are saying is that you volunteered to get in the ring and you got knocked down. So, get up and train for the next match. That's what a champion does. If you continue to do surgery, it will not be the last time you get knocked down.
You should feel honored to have a pathway to certification as I had. Remember, many of our colleagues have no pathway to certification by the ABFAS. One of the best foot surgeons in the world lives here in NC and he failed the surgical board his first time through. Quit bellyaching and resubmit. You are not the only one that has had to redo this process. Get it right and you will be certified by the ABFAS.
Don Peacock, DPM, Whiteville, NC
Other messages in this thread:
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
I am an APMA Life Member. I love APMA and its decisions most of the time, but not always. Not only can we not vote, but in the past, I have found that suggestions for specific positive actions that would benefit podiatry and our contribution to public health have been disregarded without explanation. One would think that new ideas and opportunities would be welcomed and respected and not treated with indifference. Lawrence Rubin, DPM, Las Vegas, NV
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: APMA Member
I am a life member of APMA who was solicited for a $150 voluntary contribution. I did not get solicited for my opinion on the APMA definition of podiatry. I think I'll withhold my contribution this year just like the Life Member in the August 27, 2024 PM News. That's only two of us withholding and it won't make much difference in the APMA budget, but perhaps other Life Members who have not sent their contribution might follow suit and join us. What our action does do is alert the younger members of APMA what the future holds in store for them. Perhaps APMA could count 3 out of 5 Life Members in determining our input.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
08/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Lawrence Rubin, DPM
"Medicare and private insurance cannot always identify an MD's or DO's specialty and their use of billing codes as easily as they can with a DPM after their name." - Reingold
In response to Dr. Reingold's post that suggests Medicare may not know what provider specialist such as DPM, MD, etc., is billing the claim, and that knowing this might alter a payment coverage, this is not the case. A Medicare/Medicaid Provider Number (MPN) on the claim verifies that a provider has been Medicare certified and establishes the type of care the specialist provider can perform. This identifier is a six-digit number. In addition, other than there being a few exceptions, Medicare considers podiatrists as physicians providing what it determines and publishes to be medically necessary for all specialties and is within the scope of our license.
Lawrence Rubin, DPM, Las Vegas, NV
08/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jack Reingold, DPM
I graduated from CCPM in 1979 and retired in 2023, practicing in San Diego, CA the whole time. Luckily, there were hospitals in the area that let me have surgical privileges when I started. Within 15 years, all the hospitals in my area granted podiatrists virtually full surgical privileges (including ankle) and admitting privileges. Managed care arrived and discovered that podiatrists delivered excellent, cost-effective care and began hiring them in great numbers. Kaiser Permanente Medical Group went from none to currently 21!
Hospitalists started calling us and begging us to take patients. Nobody seemed to care about our degrees, caring only if we could take care of their patients (and perhaps off their hands). The hospitals wanted us to take positions on many...
Editor's note: Dr. Reingold's extended-length letter can be read here.
08/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Joel Lang, DPM
My heartiest congratulations to Dr. Michael and his "soon-to-be-doctor" daughter for not accepting the status quo. Nothing ever changes until someone decides to change it. Sometimes it only takes a small voice speaking into a receptive ear. If she were my daughter, I could not have been prouder. Jonathan, give her a hug from all of us.
Joel Lang, DPM (Retired) Cheverly, MD
08/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jonathan Michael, DPM
I appreciate all the comments sent regarding my initial post. Here is an update to the situation: My daughter decided to have a meeting with the dean who happened to be fairly new to the school and went to a medical school with a podiatry program. She was very empathetic to the situation and told my daughter that the reason she was told "no" initially by the staff below her is that the rule was set from before she was dean at the school.
She encouraged my daughter to write a letter to the committee laying out reasons why podiatrists are physicians and surgeons. Following the detailed letter by my daughter, we got the news this morning that her wish was approved by the committee and I will (hopefully) coat my daughter at the end of the month at her medical school.
Jonathan Michael, DPM, Bayonne, NJ
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Robert Boudreau, DPM
When I entered private practice in 1984, I wanted to apply at one of our local hospitals for surgery privileges. I called and made an appointment with the chief of staff, a gruff old cardiothoracic surgeon. When I showed up, rather than meet in his office, he chose to hold our meeting in the cafeteria. After going over my credentials and residency training, he said, “I’m sure we can grant you privileges. I often have patients that need a good toenail trimming.” I tossed the application in the hospitals round file cabinet. Fast forward to the late ‘80s, early ‘90s when PPOs and HMOs hit the scene. The hospital came begging for podiatrists to come to their ORs and do outpatient surgery. I applied for privileges and was granted every privilege I asked for. As my practice grew, I had less time to travel to that facility (a 30 minute drive from my office), and since I held privileges with 2 hospitals within a 5 minute walk from my office, I made the decision to give up the privileges at the distant hospital. I wrote a letter stating my intentions to the grumpy... Editor's note: Dr. Boudreau's extended-length letter can be read here.
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Richard Haas, DPM
I have been in practice 44 years and can’t understand why the APMA has not been able to make podiatrists physicians in the eye of the law. I have seen pharmacists giving injections and physical therapists giving wound care freaking our profession out.
Being recognized as a physician should have always been the most important goal of the APMA, not worrying if we are MDP or PMD, etc. Who cares about that if we are not recognized as physicians. Where does our dues money go? DOs and dentists seem to know what to do with their money in regards to political action for their members.
Richard Haas, DPM, Temecula, CA
08/02/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
Jonathan, it’s a shame you can’t help your daughter put on her white coat for the first time in public, and, yes, I think it is a form of discrimination. For years, MDs looked down on DOs and still do, but it is much more subtle. They could always use the fact that DOs took the COMLEX licensing exams instead of USMLE and supposedly the COMLEX was easier to pass than USMLE. Now DOs can take USMLE so MDs don’t have the “we take a tougher licensing exam” platform to look down from. And, there are not enough MD graduates to fill all the residency slots in MD hospitals, so MD hospitals have generously condescended to accept DOs into their residency programs.
Don’t let the MDs kid you, there are huge economic incentives to suddenly treat DOs as academically equal to MDs, about a 100,000 reasons per resident per year. This becomes very important when rural hospitals are trying to keep the doors open and it doesn’t hurt big teaching...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
07/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Greg Caringi, DPM
I have read this thread with interest. My OCPM classmate and Kern Hospital co-resident, Dr. Eric Lauf, took on this problem and published his research in 1982, "Manual dexterity: its importance in podiatry" (J Am Podiatry Assoc. 1982 Jun;72(6):291-8.). Since Eric passed much too soon (at the age of 47), I will recall this to the best of my ability. Eric had a friend at the Case Western Reserve Dental School. Even then, dental school admissions took spatial relationships and manual dexterity testing seriously. After observing their metrics, Eric tried to apply them to the students at OCPM.
Unlike dentistry, there was a poor correlation in podiatry. His research became of practical use when Eric introduced the use of the Purdue Pegboard Test (a psychomotor test of manual dexterity and bimanual coordination) as part of the screening process in selecting residents at Kern Hospital. I later began using the Purdue Pegboard at Suburban General Hospital when we selected our surgical residents. It became an important part of our selection process. On a personal note, this reminds me how great a loss it was to our profession when we lost Dr. Eric Lauf in 2001.
Greg Caringi, DPM - North Wales, PA
07/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Steven Kravitz, DPM
I fail to understand why there is so much attention to podiatrists or at least some podiatrists trying to expand scope of practice beyond that of our specialty area - the foot and ankle. The concept of the serving as gatekeeper brings many questions, and I agree with Dr. Rodney Tomczak. The DPM degree has served me well and the podiatrists I know. My colleagues (many in wound care) have benefitted from their education and ability to practice medicine within the scope of DPM degree they earned. That degree points to the general public and more importantly to other medical providers that we are indeed specialists in the foot and ankle pathology. We have developed very good reputations generally; we as a group provide excellent service to patients. At the end of the day, it is the patient that matters.
Becoming gatekeepers necessitates overseeing treatment of medical conditions out of our scope of...
Editor's note: Dr. Kravitz's extended-length letter can be read here
07/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Observations on the Changing Face of Medicine
From: Elliot Udell, DPM
I have a patient who is a soon-to-be retired psychiatrist. Whenever he would come into the office, we would have discussions on many topics not related to psychiatry or podiatry. He was very well aware of all facets of general medicine. If I asked this physician a medical question, he knew the answer. He later told me that he works one day a week in the ER doing emergency medicine and this helps him keep up with the entire medical field. In another case, my former GI specialist who just retired was able to comment with interest and expertise on any medical issue aside from the GI system.
I am now faced with seeing a whole new battery of young specialists in different fields and if I ask them a question outside their specialty, their answer tends to be, "It's not my field, go to an appropriate specialist." I am seeing more and more of this happening and some of these doctors are board certified in internal medicine and if the question does not directly relate to their subspecialty, the wall in the room can give me a better answer.
As a podiatrist, this may be good. We are specialized and only responsible for the foot, and so many other young specialists seem to have developed amnesia to all aspects of medicine other than their own narrow specialties. Perhaps the degree given to these physicians should not be an MD or DO but for example, "doctor of orthopedics or doctor of oncology, etc. Being a doctor of medicine is becoming less and less relevant in today’s practice.
Elliot Udell, DPM, Hicksville, NY
06/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: A Rose by Any Other Name…
From: Rod Tomczak, DPM, MD, EdD
I hope all who read the letter by ACFAS and APMA have also looked at the history of the resolutions and position papers. It seems that in 2020 someone came up with the idea that if students of podiatric medicine could pass USMLE, they should be classified as physicians.
Out of the right side of their mouths, the MD officials are pushing our students to take the USMLE, and out of the left side, they are saying MD and DO passers of the USMLE can call themselves “physicians.” What seems very odd is that DOs can still take their COMLEX exam and be licensed as physicians.
This whole ploy is the biggest example of obfuscation I have ever seen. AOFAS would rather partner with Reiki practitioners than...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Elliot Udell, DPM
Kudos to Dr. Ribotsky for suggesting that there be some way of tracking podiatrists diagnosed with some form of cancer. As a cancer patient in remission, this issue is very close to me.
The medical community is grappling with another issue. Patients with breast and colon cancer are now presenting at very young ages. One patient of mine had his first colonoscopy at age forty and discovered that he had stage four colon cancer. Another young woman in her thirties is undergoing treatment for breast cancer. Are these caused by unidentified carcinogens or are people discovering these conditions earlier in life because of testing and awareness?
Elliot Udell, DPM, Hicksville, NY
06/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Tom Brady’s Formula for Success (Allen Jacobs, DPM)
From: Jeffrey Trantalis, DPM
During my residency, I was taught, “if you do good honest work, the patients and income will follow.” Too many practitioners practice for only the short-term and instant financial gain.
Jeffrey Trantalis, DPM, Del/ray Beach, FL
05/21/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Kornfeld, DPM
I think it is really unfortunate that Dr. Gottlieb quotes a book written by an economist/psychologist who characterizes self-employment vs. employment in an overly-generalized way. This does nothing to honor or include the reality that every direct-pay doctor that I know is really happy since leaving insurance-slavery or corporate employment. I would think with all of our collective intelligence that we podiatrists would stop cowering in our boots and stand up like adults for our professional experience. At some point, you need to dismiss the naysayers, who only see things from a negative lens.
As adults, we possess the power of choice. With intention, commitment and consistency, anyone who wishes to succeed in a direct-pay model will succeed. Dr. Gottlieb, it isn't fair to many of our colleagues out there who are miserable and read a post like this causing them to give up hope of achieving success and happiness outside of a system that exploits and abuses them. It feeds into fear and insecurity and has no place in these kinds of discussions.
I find it interesting as well as disturbing that not a single one of the naysayers here took the time to ask me or Dr. Roth exactly how we created successful practices and I'm certain they spent no time investigating the option. Dismissal comes from small-minded thinking. Success comes from an open mind, self-esteem, and an ability to shut out all the rhetoric of those who are too afraid to stand up to the monster that the system has become.
Robert Kornfeld, DPM, NY, NY
05/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Kornfeld, DPM
Since this thread is still going, I would like to bring up a really important point that Dr. Meisler glossed over. Patients coming from these concierge practices were willing to pay directly when they came and were "surprised that they did not have to pay at the time of their visit." That should tell you something about the value they are experiencing in a direct-pay practice. That's number one.
Number 2, I agree with Dr. Meisler that eliminating poor payors will always make room for more value in the practice. However, it is important to note that as long as you continue to accept insurance, you will always be fighting an uphill battle. You will need to see a high volume of patients which means a large office, large staff, and high expenses. You will still have to navigate the slippery slope of...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
04/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: The Future of Podiatry - Part 2
From: Allen M. Jacobs, DPM
As we move forward (I should say you, as I'm on the 18th green and putting out), there must be a realistic examination of the future of medicine. As corporations and healthcare institutions continue to take over medical care, and insurers evaluate our care, the bottom line is cost-effectiveness. This is a major reason why NPs and PAs are replacing MDs and DOs as independent healthcare providers. This is a driving force for pharmacists beginning to provide healthcare. It is a driving force for urgent care centers replacing emergency departments, surgical centers providing services; we can site example after example.
Ultimately, insurance carriers want the least expensive medicine provided, whether it be testing, office fees, drug choice, or procedure selection. Industry, such as corporate-driven medicine, to the contrary, wants you for profit. You are evaluated by industry first and foremost by the profit you generate. The conflict between industry and...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatrists and the USMLE
From: Rod Tomczak, DPM, MD, EdD
I have recently heard from several DPMs that because we teach essentially the same curriculum as the MDs, “I’d bring Steps 1 and 2 USMLE to their knees.” It’s not what is taught in the podiatry schools that concerns me, it’s what is not taught that scares me.
In case anyone would like to explore what is not taught in the podiatry schools, I invite any podiatrist who figures we are just a month’s rotation in obstetrics/gynecology and a month’s rotation in psychiatry from an MD degree to explore the samples of USMLE Steps 1 and 2 which are posted at: Here and Here.
I think anyone who passes the two sample exams, can take a black Sharpie and cross out the word "Podiatric" in Doctor of Podiatric Medicine and become Doctor of Medicine.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
03/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Paul Kesselman DPM
While there are not many 80+ year olds in leadership positions in podiatry, there is one here in NY for whom if I did not comment I would simply be ashamed. Dr. Arthur Gudeon has been a shining light in this profession here in NY for more than 60 years. He is 89 and shows no signs of slowing down. There are many podiatric bambinos who Arthur has mentored and yet he still finds time to practice and play tennis a few days a week. If not for Arthur, podiatry would certainly not be where it is today in NYS.
Paul Kesselman, DPM, Oceanside, NY
03/11/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
I could not be more pleased than I am with the responses from Drs. Uro and Jacobs. I have never met Dr. Uro, but I’ll posit the two of us would get along famously. Dr. Jacobs was one of my trainers when I was a resident and we have been good friends from the first day. When I taught in Des Moines, he graciously took all levels of students, inspiring all of them to become excellent clinicians. When I had to make podiatric relevant decisions, I always thought WWJD, but refused to wear a bracelet advertising such.
I applaud Dr. Uro for having the courage to say he would not recommend podiatry to a college student today, in spite of the fact he loved the profession for 45 years. This begs the question why he would not recommend something he thinks was so...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
03/04/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Ivar E. Roth, DPM, MPH
I have been told by a very reliable source that the new schools opening is like a Ponzi scheme. There are funds available by the feds, etc. that allow these schools to be subsidized. Thus on paper, it can be a money-making proposition; however in reality, we do not have enough students to choose from, thus low enrollment and students with lower MCATs and GPAs are being admitted. We do not have enough residencies if all the schools were filled to capacity based on the number of podiatry schools now open. We are in a tough situation.
I hope everyone reading this post gets energized and goes out and speaks at a local high school or college and promotes our wonderful profession so we can grow in a positive direction for the future. I think our component societies should contact all local high schools and colleges and offer their members as speakers.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
02/16/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Ivar E. Roth DPM, MPH
I think you could sue for failure to refer to an appropriate medical doctor. If a generalist cannot figure out the problem, there is a duty to refer to a specialist.
Ivar E. Roth DPM, MPH, Newport Beach, CA
02/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Cynthia Cernak, DPM
My daughter was recently the patient of a family practice which failed to diagnose congestive heart failure. I was told by a malpractice attorney that we do not have a case, as a family practice is not qualified to diagnose this condition. The same daughter saw an optometrist for over 4 years, and they missed keratoconus, so now she is legally blind. Attorneys say she cannot sue optometrists, as they are not medically trained. But, yes they charge for an eye exam?
In conclusion, you cannot sue a store practicing podiatric medicine without a license. I doubt the GOOD FOOT store does any kind of exam. I doubt the patient is even asked to even remove their socks.
Cynthia Cernak, DPM, Kenosha, WI
02/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Dominic Bianco
Public knowledge and educating the public is really part of the answer. The other part is the patient has to feel confident and comfortable with their choice when seeking medical attention.
Retailers are now selling custom-made orthotics utilizing shippable impression kits. These start at $200. Originally, they were only available through podiatrists who were selling to their patients custom orthotics for $200 back in the 1980s. Now it seems these products are widespread, not just in custom orthotics but for all kinds of podiatry products.
Podiatrists, on average, are seeing 10-20 patients per day. Overseeing their practice and growing it takes a lot of...
Editor's note: Dominic Bianco's extended-length letter can be read here.
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