International podcaster Tyson E. Franklin and Alan Sherman, DPM recently recounted the story behind the development of Podiatry Online and PRESENT e-Learning Systems and the part that it has played in the ongoing advancement of the field of podiatry. 21st century online education came early to podiatry, when PRESENT e-Learning Systems first put lectures online for podiatric residents at PRESENT Podiatry in 2003. Two years later, they introduced the first online CME education program for podiatrists with full video lectures and in two more years in 2007, they ran their first live CME conference. In those 16 years and 50+ live conferences later, they’ve built out an advanced online service to deliver reliable, high-quality accredited education to podiatrists, from residency to retirement, that runs on smart phones, tablets, laptops and PCs.
Tyson Franklin: The current business that you run is PRESENT e-Learning Systems. But prior to that, you were doing Podiatry Online way back in 1995, which seems a long time ago for people to be using computers.
Alan Sherman: I had been using computers for 14 years by 1995 because I practiced in Boca Raton, Florida, which was the town where IBM had its headquarters for designing and manufacturing the original PC. So for years, I had these young, eager engineers from IBM coming in as patients, telling me about this marvelous machine that they were working on and it was going to change everything once they had it ready.
I got my first PC in 1982 and formed a group of my physician friends who were all interested in using our new toys. We would take them apart and put them back together. We’d upgrade them and tune them for maximum performance, a little like the hotrod cars in the 50s. We bought a scanner. We started doing photography on the machines and that was back when it was either a green or an amber light on a black screen, and then there was a 16-color screen, and then there was software interpolation that made the pictures more photo-realistic and all of a sudden we had a digital photo darkroom with a computer.
We enjoyed being hobbyists for those 14 years. And then the miracle happened that the Internet was introduced to the public in 1991 and Marc Andreessen, the genius engineer from University of Chicago had the foresight to release the Mosaic web browser to everyone for free. All of a sudden, it was off to the races, and that’s how I got started with this.
I think, fundamentally, many doctors are kind of geeks in general. We like science, we like learning, we’re curious. Podiatrists, in general, are into high-tech hardware. The computers were just a delight for me and kept me very interested through those 14 years even before the Internet.
Franklin: Well, my first introduction to computers was probably around the same time, but I was still in high school then—we had to type different punch cards and then it was 0, 0, 1, 1…Is that how you started?
Sherman: I had a similar experience. I did my undergraduate at Colgate University. They were one of the first schools, along with Dartmouth, that had a requirement to take a computer course. We had punch cards and there was a mainframe. And then they got a hard drive that looked like a washing machine where they would mount platters in it and they would have to do all those calibrations and then start using it. So I learned ALGOL and Fortran programming just a little bit when I was in school because I was required to.
Franklin: In 1995, you were kicking off Podiatry Online. So is this when the Internet started for podiatry?
Sherman: Yes. I was one of those million people who downloaded the Mosaic web browser in the first few days and started exploring the “world wide web”. There were very few websites at that time. After exploring a bit, I had the realization that this was going to be a very useful tool for a field that I really wanted to get into and that was publishing.
At the time, there were two major print publications in podiatry. Barry Block was doing Podiatry Management and Judith Rubinstein was doing Podiatry Today. I admired these people enormously and I knew all podiatrists were benefiting so much by the work that they were doing. I realized that I could get into publishing without printing, without having the big initial capital expense and I could sort of ease my way into it and try things.
I set up my first website, the Podiatry Online, in 1995. I used a local company to do my hosting where I could actually go to their plant that’s near my home and go into the room and see the computer that I was sharing space on. It was in a room the size of a bedroom closet. I think it was about 10 by 10 or 10 by 12. They were a rapidly growing web hosting company called Hiway Technology. They had brought all these extra portable air conditioners into that room in order to keep it cold enough and that’s where the original Podiatry Online was hosted.
Franklin: How did you learn how to create a website?
Sherman: I learned on the Internet because the Internet was starting to be the greatest way to learn a new field. At the time, I was comparing it to a library which, of course, it has become much more than, but it was at least a library then and soon to be a great one. If any of us wanted to know something new at the time, we would go to a library and take books off the shelf and work with the researcher. But now we had the World Wide Web and it became so much easier. So what did I learn? I learned website programming. The first Podiatry Online was a very rough rudimentary website, but it allowed me to start putting up on that website information that was of value to podiatrists. I started out with advice on how to run their practices, and how to treat patients effectively. So it was medical treatment and it was practice management advice. I started by taking the patient information brochures that I had written for my practice and the forms that I used to move patients through the practice. I put them online and allowed podiatrists to freely download them and use them. Like the rest of the Internet at the time, it was all about sharing information.
Franklin: Franklin: How did you let podiatrists know that this information was available way back then?
Sherman: They found me. I didn’t have to let them know. Who was it at first? It was the hobbyists, the podiatrists like me who were just curious. They did a search, and back then (this was before Google), there were other search engines like AltaVista and Lycos. When they put the word podiatry in there, they would find Podiatry Online. So when they came to Podiatry Online, the first thing I asked them was, “Would you like to receive our newsletter?” They would fill out a simple form with their email address and that became our first mailing list. I started sending out the Podiatry Online Newsflash, my email newsletter.
At first, it was once every couple of weeks and then it was once every week and that’s back when we had about 50 followers, and then there were a few hundred, and then there were 500, and then I got it out about once a week. The newsletter started out as things that I wrote and advice that I gave to the podiatrists. Gradually, they started sending in questions and I did my best to answer the questions. I tried to answer them quickly because they were very often clinical questions. “I have a patient who came in with this and this and what do you recommend?” Or “I just did this and I need to send a claim into an insurance company; how do you recommend that I describe this or code this?” or “I’m having difficulty keeping staff; what do you recommend?” They needed answers quickly and I tried to accommodate their needs.
I would give them an answer and the greatest thing that happened is, gradually—and I was up to about 1,000 members at this point—they started becoming dissatisfied with my answers. So they would say, “No, don’t do this, do this or this is what I’ve done for years.” It was kind of a sharing and kind of a—maybe a little competitive, but gradually, they started answering each other’s questions. Someone would send in a question and I would publish the question and I would give an answer and someone else would send in another answer. The nature of the Podiatry online NewsFlash was changing from a personal answer service to an online sharing community of podiatrists. Gradually, I was able to step back and become the curator or the editor for this, rather than the sole writer. By that time, In 2000, we had 8,000 subscribers.
Franklin: Were the majority from North America or were you starting to get some from overseas as well?
Sherman: I always had a small percentage from outside the U.S. Currently, it’s about 10%. But it was about two-thirds of the podiatrists in the U.S. We had about 12,000 podiatrists at that time. By the year 2000, I was publishing every day because the volume was such that if I didn’t, I would get behind. I was getting about 150 letters to the editor every month at that time. So I was busy doing this, and my family wasn’t seeing me very much.
Franklin: How did you fit that in with running a practice and having a life at the same time?
Sherman: I did it almost all in the evenings and during my lunch hour—I really enjoyed it and it was exciting that I was sort of hosting this discussion among a large group of my peers. I loved getting to know the members and loved the opportunity to help them be better at what they do. So my family was seeing the back of my head a lot, facing the screen, and they didn’t get it. At that time, I just was excited by the forum. I didn’t see it really so much as a commercial thing. It was a project in community building via electronic publishing.
I was starting to see the potential there because I saw other people in other industries starting to make a business out of their websites. Then, a good friend of mine by the name of Michael Shore, DPM started asking me about it. He was one of the subscribers and he wanted to help make it into a business. Michael was always very entrepreneurial and had quite a few talents that I didn’t have, chief among them being a great salesperson and a great people person. He just loves to talk to people and he started selling—or trying to sell banner advertising. Companies like IBM, Lucent, and AT&T were selling banner advertising at the time. But in podiatry, it was very new. When he went to the potential advertisers, they didn’t quite get it yet, so he was not having a whole lot of success but did have enough success to keep working at it.
Then I got a phone call that literally changed my life. I got a call from a woman named Linda Autore who was the CEO of the largest supplier to podiatrists at that time, a company called Moore Medical, which is still in business today. Linda had just joined Moore Medical (coincidentally having worked previously at IBM), and she was working in Boca Raton, Florida. Moore Medical recruited her because she was working in the e-commerce space for IBM and they wanted to e-enable their sales channel. This was a company that would send out a catalog once a month and that’s how they supplied podiatry offices. I ordered most of the supplies for my office from them. You’d call them or send a fax in to place an order. That was basically it but they wanted to e-enable, so Linda told me that she was going to be in Florida the following week and she would like to meet me. She had been told about me and the mailing list and the Podiatry Online publication via a friend by the name of Henry Stark, DPM, who practiced in Jupiter, Florida. Henry was a longtime customer of Moore Medical and a friend of mine. He said to Linda, “Well, you should talk to Alan; he has a big online community of podiatrists.”
Linda flew down from the Moore Medical headquarters in New Britain, CT, to meet with me and said, right off the bat, we want to buy you. I didn’t know the first thing about selling a company. I’d never sold a company. I told Michael, who got all excited. Right away Linda hired a colleague from IBM, a private Internet industry consultant who sort of helped her in vetting us. So, they asked for a lot of reporting. They wanted to know everything about it so I provided all the information, the site metrics, to them.
Michael started talking to his cousin, Vic Weinstein, MD, who was an emergency room physician, one of the founders of the American Board of Emergency Medicine, and an incredibly successful businessman. He became our adviser in the sale of the Podiatry Online company to Moore Medical. He was a great advisor and generally was the smartest person in the room when the Moore Medical people were there. He introduced us to a very talented attorney and merger expert, and we sold the company in 2000 and then Moore Medical employed us for a couple of years to run it.
It was a life-changing thing, both the experience of selling a company and also the fact that they poured a lot of money into it, completely redesigning the website which was really very rough at the time. They made it look and function nicely, between 2000 and 2002 when we were working for them. I would still run my practice for five more years but, more and more, I was stealing time from patient care to run Podiatry Online.
Then something interesting started happening. We had gotten a portion of the purchase price for the company in stock. We got it at seven; it went down to below two. We figured it would never be worth anything and this was typical of companies that sold Internet companies at that time. But then the stock started going up. So, the stock went to four, the stock went to six, the stock went to eight, and it was finally higher than what we got it at. We started making inquiries about it and it turned out that Moore Medical had gotten an offer to buy them from McKesson.
Then another company made a competing offer. The stock went to 11, the stock went to 12. We ended up selling all of our stock, and Moore Medical ended up selling the company to McKesson. Moore Medical was a $120 million company at that time while McKesson was a $3-billion-dollar company. The Moore Medical CEO, Linda, made a lot of money and McKesson immediately fired her. In fact, they fired the entire executive staff and put their own people in but kept the name and fired us. So, in 2002, I had one year left on a restricted company. I could not do anything else in that space and went back to running my practice.
Franklin: Did they give a reason why they bought something that had been working well, that had a great connection with podiatrists, and then once they’d taken it over, they gave everyone the boot?
Sherman: We eventually found out. We were going up to New Britain, Connecticut every six months. Each time, we presented to their sales team, giving them marketing plans for how to use the Internet and Podiatry Online to improve their marketing to podiatrists. This was over the course of two years, and they never ever did a single thing that we recommended. We were frustrated because we wanted to see this be a success for us and them. It turned out that they were using those marketing plans to shop Moore Medical out for acquisition and it was successful. They ended up selling the company and McKesson took it over. They already had an E-channel which wasn’t yet successful but then McKesson made it into what every company eventually did, which was to make it into just another way of selling the products. So, yes, we found it very strange and we didn’t find this out until Linda disclosed this to us after the sale went through. PM
Editor’s Note: Part 2 of this interview will appear in our June/July issue.