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07/28/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From Gary S Smith, DPM
Adam Siegel, DPM said he gave the ACA an "A" rating because of the benefits it gave him towards his healthcare. He makes a great point of discussion, which really defines the pros and cons of the ACA. There is no doubt that it has provided great benefits to some people, especially people with pre-existing conditions. The other side is that since I am self-employed, the amount I pay for my insurance has doubled. The effect on my practice and also my three sons in college has been noticeable.
All across America, people are not getting the care they need or engaging the healthcare system due to their high deductibles. The average person has to take money out of their tight family budgets to pay the increase in personal healthcare costs due to the ACA. So, really the big question is, Dr. Siegel, What makes you so special? I sympathize with your health concerns but could you please explain why it is mine and every other person in this country's responsibility to pay for your meds? Why do people have to get less care, have less money for college, less money for their own medications, and less money for their families just so you can have a very expensive medication? I'm not trying to be uncaring, but you brought up the analogy, so please explain to us now what makes you so special?
Gary S Smith, DPM, Bradfors, PA
Other messages in this thread:
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.
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.
05/19/2022
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1b
From: Alan Sherman, DPM
There are some very good reasons why we podiatrists should have a lower incidence of COVID than the general population. Doctors, in general, are among the most vaccinated population. We podiatrists are so well educated in infectious disease and the precautions that we need to take to keep our staff and patients safe. We spend so much time in operating suites where the principles of antisepsis have been followed long before COVID.
I don’t find it surprising that our incidence of COVID as a group is lower than average, but rather, that it is a testament to the policies that were put into place and the practices that were diligently followed in our offices and clinics, as well as in our personal lives.
Alan Sherman, DPM, Boca Raton, FL
05/17/2022
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Dennis Shavelson, DPM
The biggest mistake we made as a profession continues to be to ask “Is it covered?” as a prerequisite to care. The second biggest mistake has been the simultaneous abandoning and minimizing of lower extremity biomechanics. We have neglected our inherited claim to be the best orthotic and closed chain professionals that Drs. Root, Langer, and Dananberg gifted us by instead becoming amateurish, uneducated, and unskilled.
This year, I tearfully retired as a DPM. How did we let this happen?
Dennis Shavelson, DPM (retired), CPed, Tampa, FL
05/12/2022
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Steven Finer, DPM
I applaud Dr. Kornfeld’s personal journey. I did not have the guts to do what he did and accepted Medicare. I always made a living .However, those 1978 fees adjusted for inflation are the same as 2022. My son could easily have gone into medicine but is in the business world. None of my friends' children chose medicine. My personal physician is leaving the big group as more and more patients are pushed on him. My excellent dermatologist looks tired and harried as the big group pushes him to do more. None of their children have gone into medicine and both sets are husband and wife MDs.
Steven Finer, DPM, Philadelphia, PA
04/05/2021
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Kenneth Meisler, DPM
Dr. Kass stated "like Dr. Meisler does with ultrasound guidance," he injects "into the region of the neuroma...is a pretty easy location to find without ultrasound." I agree that to be in "the region" is pretty easy. I do not inject into "the region of the neuroma." I inject directly into the body of the neuroma. I have done this for about 15 years after reading a study performed this way at the Hospital for Special Surgery. I have found injecting directly into the neuroma under ultrasound guidance is more effective than injecting in the region of the neuroma, which I did for 25 years. It is difficult to do even with ultrasound guidance. There is a definite learning curve.
I think you will be surprised where you are injecting as you watch yourself under ultrasound. Eventually, it becomes quite easy. Injecting directly into the neuroma also reduces complications such as fat necrosis and skin discoloration because the firm body of the neuroma holds the steroid or alcohol within it after the injection. A comprehensive review of the literature on ultrasound guided vs. non-ultrasound-guided injections in the Orthopedic Journal of Sports Medicine concluded that ultrasound-guided injections are overall more accurate than landmark-guided injections. I perform all neuroma injections under ultrasound guidance even if the insurance company will not pay for it. I cannot ethically do an injection without it if I know I am capable of being more accurate with ultrasound; that's just me.
Kenneth Meisler, DPM, NY, NY
01/05/2021
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Henry Stark, DPM
Almost by definition, temperature in the human foot is normally less than core body temperature. I think we can all agree that there is no need for double-blinded studies to determine this to be a fact. During a hyperuricemic episode, it is believed that urate crystals coming out of solution from a “saturated” plasma concentration, precipitate in these naturally cooler, distal articular regions which initiate the gouty attack. In conjunction with other therapeutic measures, many podiatrists utilize posterior tibial blocks to induce a temporary, localized sympathectomy for increased perfusion as well as the analgesic effect. Yet, the Arthritis Foundation, most all rheumatologists, as well as most of my colleagues would argue that ice (rather than mildly increasing the temperature of the site) is appropriate therapy for the ACUTE phase of the attack.
Dr. Levy appears to suggest (as do I) that consideration towards increasing perfusion (and perhaps warming of the affected area of the gouty attack) rather than ice may be more appropriate. Yes, ice is an analgesic in this situation, yet its use seems counterintuitive since it decreases temperature, perfusion, and would tend to prolong and enhance localized urate crystal formation. I am aware that once a gouty attack has begun, uric acid concentration in the plasma often has already decreased. Why would ice be the recommended therapy simply for analgesic purposes, when it may cause further, localized urate crystal formation?
Henry Stark, DPM, Lake Park, FL
12/23/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Elliot Udell, DPM
Dr. Tritto questions the use of posterior tibial nerve blocks in light of the fact that there are no published studies supporting their efficacy. The point he is making is well taken. Even though the late Dr. Marvin Steinberg, who was regarded as the father of modern podiatric medicine, showed that by blocking the posterior tibial nerve, a patient could be rendered almost asymptomatic within minutes, there are no studies published in any peer-reviewed journals supporting it. Why?
Studies cost megabucks and no pharmaceutical company will invest millions of dollars into showing that PT blocks are helpful, when there is no way they will make money off of the procedure. What makes it worse is that most insurance companies will not pay for PT blocks because there is no research. Could there be research and publications on PT blocks? Sure! Our professional associations along with our colleges of podiatric medicine would have to fund the research without corporate sponsorship. If enough of us want it to happen, maybe it will.
Elliot Udell, DPM, Hicksville, NY
07/03/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Estelle Albright, DPM
Thank you Dr. Markinson for your advice: I will further refine my methods of nail care with improved type face masking, and face and head cover, similar to operating in the OR. Currently, I mask and glove, wear glasses, and use sharp, sterile-bagged double action bone cutters for hard nails and use Miltex 40-226A nail nippers for non-dystrophic nails. I do not grind nails.
I treat fungal or dystrophic nails medically with oral antifungals and/or nail softeners, or surgically with matrixectomy or nail avulsion. My aim is cure, not maintenance. Granted, this is not an option for some patients, but for most, be the physician that you are: Treat with your best knowledge and skills.
I use a 12 month treatment plan for non-surgical nail fungus patients. This includes ketoconazole shampoo for foot washing, topical antifungals, environmental clean- up/disinfection instructions, patient education/brochures, and UV light shoe disinfection with SteriShoe/similar device. I have a very good cure rate. Many of these patients had severe, chronic nail and skin infection (often since military service, or with poor circulation or diabetes). Patients are happy and grateful to be cleared of the infection. I follow patients at 4, 8 and 12 months. I think that ultimately podiatry will endorse protection like I see at my dentist's office; this is surely the path of the future.
Estelle Albright, DPM, Indianapolis, IN
07/02/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Bryan C Markinson, DPM
A simple search of the global microbiological, occupational science, radiological, and infectious disease literature dating back 2-3 decades will reveal a plethora of citations in the potential dangers and actual incidence of respiratory illness from inhaled nail dust and the microbes that tag along with it. A British NHS study reveals 4x the incidence of asthmatic-type illness among podiatrists.
If Dr. Moglia won’t be convinced until he sees dramatic numbers of lung cancer cases, which he won’t, then he should stop wearing seat belts and bicycle helmets. And another word to the wise, should any podiatrist be immunocompromised by any number of medical issues and or
treatments, the risk is...
Editor's note: Dr. Markinson's extended-length letter can be read here
02/25/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Don Peacock, DPM
Residents need to be trained in surgery. During school, we are taught how to assess a patient from a biomechanical standpoint and how to cast for orthotics. We certainly are taught how to administer palliative care and even contact casting. We are taught how to interpret vascular exams and do rotations through vascular departments while in school.
We were also taught how to do ingrown nails in school. I did ingrown nails with phenol procedures while I was in school. These things can easily be taught in a busy podiatric medical school clinic. In our fourth year, we do rotations through the various disciplines that we pick or we rotate through podiatric surgery residencies that perform both...
Editor's note: Dr. Peacock's extended-length letter can be read here.
02/21/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Joe Agostinelli, DPM
I respectfully disagree with Dr. Peacock’s comments on doing away with waste of time rotations and only teaching surgery to our podiatric residents. I come to this because of my background as a DPM in the USAF for 23 years in orthopedic clinics, then 13 years in private practice with a large orthopedic surgical group as their DPM.
During my first assignment at a USAF hospital that trained 25 orthopedic surgeons, I quickly realized the need to become a “good doctor first“, then a surgeon after that. The four years of podiatry school gave us the background in biomechanics, surgery, palliative care, etc. and the mostly...
Editor's note: Dr. Agostinelli's extended-length letter can be read here.
02/20/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Michael M. Rosenblatt, DPM
Robin Lenz, DPM recently wrote a letter explaining how important wound care issues are and should be a part of every DPM residency. I strongly agree. Some years before I retired, I heard an orthopedist who routinely used Achilles Tendon lengthening and gastrocnemius recession to treat very severe diabetic ulcerations, even for patients with very poor circulation. He presented sound evidence that this should be a “part of podiatric care” for diabetic ulcers. He made the point that DPMs should be doing MANY more of these than presently done. He also used some tendon releases in other tendons, but most of his surgery was gastroc recession and Achilles tendon lengthening.
When questioned about malpractice risk for patients with very poor circulation, he provided data that showed virtually NO...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
01/27/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Jon Purdy, DPM
There are things to consider with investments that are not often discussed. In real estate, people often talk about their return on investment as what they sold minus what they bought the property for. They often fail to include the over-time expenditures of interest, insurance, taxes, utilities, and maintenance. Often, these investments are a loss after the positive sale of a property. Often not included is the calculation of what those monies, had they been invested in the market, would have returned in those years. True analysis of monetary return on investment is very complex. I find people in business routinely do not understand their true costs of doing business, not having taken into account numerous cost considerations.
Jon Purdy, DPM, New Iberia, LA
01/24/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Bob Hochron, DPM
The survey question is an interesting one, because it really refers to only one side of the important equation. Having retired almost five years ago, I have been asked this question by many friends and colleagues. The quickest way to answer this is to pose the rest of the question: How much do you need to live on?
My suggestion is to start with a clear and comprehensive idea of what it actually costs you to live for 3 years. I recommend every dollar spent be tracked with a simple program like Quicken, which...
Editor's note: Dr. Hochron's extended-length letter can be read here.
01/23/2020
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Steven Finer, DPM
A carefully managed portfolio spread out among stocks, bonds, and tax-free bonds will do well. I prefer using at least two separate managers. Good rental properties can do very well beating the markets; however, they can be nightmares. I and some of my friends have both good and horrible stories to tell.
Finally, the determining factor will be your health. Unfortunately, [if you have health problems] the money will almost become meaningless. We have all witnessed these situations.
Steven Finer, DPM, Philadelphia, PA
12/12/2019
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Don Peacock, DPM, MS
These percentages seem relatively low compared to busy podiatric surgeons in NC. We do have some highly trained podiatrists who are not routinely doing bunion surgery because they are performing bigger reconstructive procedures.
In rural areas, the need for bunion correction is much higher than the numbers reported here. I suggest that podiatric surgeons finishing their training consider a small town practice where your HAV surgical load will be considerably larger than these averages reported.
Don Peacock, DPM, MS, Whiteville, NC
10/12/2019
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Judd Davis, DPM
The government has a special fund called the National Vaccine Injury Compensation Program to compensate individuals who have been permanently injured by vaccines of various kinds including seasonal flu vaccines. According to their website, to date, it has paid out $4.2B in injury settlements. This does not include amounts paid out via traditional lawsuits, so who knows what the real damages are. The site says the injury compensation rate is about one person per million vaccines administered. However, I have had a fair number of patients over the years that suffered Guillain-Barré syndrome after various vaccines, so I have to wonder how accurate their data really is?
I imagine most of the general public is not even aware of this fund or the potential risks of getting vaccines as I have not seen it discussed by the mainstream media, and therefore individuals may not seek damages when injured. It’s something to think about and might help your patients get compensation if they have major side-effects. The website is an eye-opener.
Judd Davis, DPM, Colorado Springs, CO
10/10/2019
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: David Secord, DPM
Question: Does the evidence support the call for universal influenza vaccination?
Response from Eric A. Biondi, MD, MS, Assistant Professor of Pediatrics, Pediatric Hospitalist, University of Rochester Medical Center, Rochester, New York
Response from C. Andrew Aligne, MD, MPH, Assistant Professor of Pediatrics, Director of The Hoekelman Center, University of Rochester School of Medicine & Dentistry, Rochester, New York
Influenza vaccination is a yearly ritual. The Advisory Committee on Immunization Practices (ACIP)[1] and the American Academy of Pediatrics (AAP)[2] recommend annual influenza vaccination for...
Editor's note: Dr. Secord's extended-length letter can be read here.
05/16/2018
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Narmo L. Ortiz, Jr., DPM
Once again, PM News visits the issue of what office attire our colleagues wear in the office. Nevertheless, when a colleague expresses his or her "feelings" on the issue in this forum, and blindly shames or belittles his or her colleagues for what attire they choose to wear in their office, it is very unbecoming and unprofessional. It speaks volumes about the person who claims to be a "professionally dressed" doctor.
Narmo L. Ortiz, Jr., DPM, Lakeland, FL
05/15/2018
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Charles Morelli, DPM
When I first got into practice 28 years ago, I wore slacks, a dress shirt, tie, a new lab coat and $200 shoes. After the first year seeing my dry-cleaning bill soar into the thousands of dollars, I quickly changed how I dressed. If I was a primary care physician who did nothing more than check my blood pressure, listen to my lungs, look in my ears, etc., and then call in his nurse to do everything else, I too might dress in a shirt, tie, and a lab coat. In my practice as with many of us, I am continually exposed to not only wounds and bodily fluids, but also things like Betadine, silver nitrate, and gentian violet that can turn an $80 pair of slacks in to garbage (not to mention the shoes). The PCP does not, nor does any other doctor who does not do what we do.
I now wear clean, professional scrubs, embroidered with my name as well a crisp lab coat. I never dress “casually” as if I am going to leave and rush to my second job at Walmart. When I had my kidney transplant and met the man who was going to save my life, I assure you I didn’t care how he was dressed; or she for that matter. He walked into the room in scrubs and his hospital issued lab coat was professional, and he proceeded to take my history. Quite frankly, it was a comfort to see my surgeon dressed as a surgeon.
Charles Morelli, DPM, Mamaroneck, NY
03/15/2018
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Elliot Udell, DPM
When literature out of England came out many years ago showing that podiatrists who grind mycotic nails were at risk of developing pulmonary problems, I took all of my drills and tossed them in the pail. Being an allergy sufferer, even the expensive vacuum systems did not prevent me from wheezing after doing a nail grinding.
How did my patients react to this change? Some left for other podiatrists, but most stayed. I explained to them that not only will they be breathing in their own mycotic nail dust, but they will be breathing in the infected dust from every other patient we saw in the last 12 hours.
I also believe that there are OSHA laws that require that a treatment room be left unused after grinding infected nails for a period of 8-12 hours. This makes sense and I do not regret not grinding toe nails. We all took the oath to help and do no harm, and grinding mycotic nails dances on the border of violating this oath.
Elliot Udell, DPM, Hicksville, NY
12/14/2017
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
RE: Will eliminating the ACA mandate help podiatry? (Joel Lang, DPM)
From: Bryan Markinson, DPM
Dr. Lang seems to intimate that it is obvious that podiatry as a profession is better off with the ACA mandate requiring the purchase of health insurance. I am not so sure. My vantage point is from an academic medical center-based practice which is a full-time private practice and a part- time hospital clinic practice. The private SPECIALTY practices largely do NOT participate with most plans offered on the health exchange, which is also true of most of the community-based podiatrists (this is a supposition that I cannot verify).
The specialty clinics largely do participate with the exchange plans, which seem to be nothing more than...
Editor's note: Dr. Markinson's extended-length letter can be read here.
03/31/2017
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: Brian Kiel, DPM
There is no medical specialty called foot and ankle specialists. There are podiatrists and orthopedic surgeons who specialize in the ankle as well as the foot, but no school gives a degree in the foot and ankle. This change completely eliminates the word that defines who we are. Now, if the desire is to mask who we are and pretend to be something we are not (hint-hint), then this might work, but I am a podiatrist and want to be known as one. Thirty or forty years ago, the general public was not as familiar with the word podiatrist, but now not only they but the medical profession knows us as such.
We get MD referrals who tell their patients that they need to see a podiatrist, not a foot and ankle specialist. If we become foot and ankle specialists, what is to separate us from orthopods? Nothing. We are podiatrists; we treat the foot and ankle in various ways and the constraints of what we can do is often limited by law. All of us are not ankle surgeons, and to imply that we are is not good for the profession. What we do, we do well. No other profession comes close. Let’s not hide who we are.
Brian Kiel, DPM, Memphis, TN
11/21/2016
RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B
From: George Jacobson, DPM
There are far too many variables and negative assumptions being made in the responses to this question. Insurance plans have limits and exclusions that will affect our treatment both as patients, as well as our patients' choices for non-covered services and service limitations. I am currently getting physical therapy and needed pre-approval which could have been denied causing a change to my doctor's treatment plan. If I need more therapy after my limit has been reached, my treatment plan may again be altered by my doctor or I could pay out-of-pocket, which most of my patients wouldn't do or could not afford. We all know what other "covered" treatments are available.
Another nuance to "therapy limits" is the decision to "waste" visits on "minor" injuries as they may be needed later for major rehabilitation post-stroke, joint replacement, etc. Many years ago, these were separate therapies but they were all lumped together by Medicare, further reducing Medicare's benefits and exposure. We can use up someone's therapy benefits for plantar fasciitis and they could have a stroke and need speech therapy, occupational therapy and/or physical therapy, but now their treatment plan must change because of their insurance coverage. Therapy is just one example. We should not be so quick to judge this survey's outcome as it is too broad a question to warrant the condemnations posted. It is a far different situation from the ethics and warranted condemnation for performing or changing procedures just to meet certification requirements.
George Jacobson, DPM, Hollywood, FL
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