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RE: Lack of Podiatric Authors in Our Journals

From: Joseph Borreggine, DPM


Can anyone explain why the authors of most of the articles in our podiatric journals are now written by mostly non-DPMs, foreign doctors, and others not in the field of podiatry?


I remember the days when all I ever saw was solely DPMs authoring in these journals that represent this profession. I recognize none of the names of those who are published in these journals. Does this mean that we, as profession, are no longer interested in research and writing about what we do anymore?


Have we just left innovation and outcome studies in the hands of others who have nothing to do with podiatry, or are these journals now just a platform for a totally new and international audience specializing in foot and ankle medicine and surgery?


Joseph Borreggine, DPM, Charleston, IL

Other messages in this thread:



From: Tip Sullivan, DPM


For the immediate complaints--


1- Remove the screw in the second metatarsal and shorten the second met.

2- Repair the plantar plate. Remove the base of the second proximal phalanx only as the last resort. This foot is biomechanically unstable and you can bet that the second toe will not stay where you want it. 


I would also discuss repair of the 1st MTPJ (the sesmoids are not in good position) as well as some soft tissue adjustment at the 3rd MTPJ. You need to follow this up with functional orthoses.


Tip Sullivan, DPM, Jackson, MS



From: Ira Baum, DPM


Dr. Shavelson proposes a reasonable question, but I fail to understand its purpose. From the statistics from the 2019 CASPR Directory describing program offerings to podiatric medicine graduates, there is an overwhelmingly number of PMSR/RRA vs. PMSR. That indicates podiatry is or is becoming a surgical specialty. I don’t think that prescribing orthotics and performing rehab or skilled maintenance defines a podiatrist with surgery as a sub-specialty. 


If, on the other hand, podiatry offered respected post-graduate residencies in other areas, for example podopediatrics, pododermatology, lower extremity manifestations of endocrine diseases, etc., maybe there could be a discussion, but that isn’t likely to occur. The real question is: if podiatry pigeonholes itself into a surgical specialty, why is it necessary? If podiatry remains on its current course, the AOFAS has an insurmountable advantage. If podiatry remains on its current course, will it survive? Should it survive?


Ira Baum, DPM, Miami, FL



RE: Practice Management and CPME

From:Alan L. Bass, DPM


By way of personal history, during my time at NYCPM in the early '90s there was very little, or any business management education given to us as students. The mission of the college at the time was to prepare us for residency. Then during [residency], as it most likely is today, there was no little to no time for this either. When I started in private practice and returned to NYCPM in the late '90s as part of the Department of Medicine, I thought it was important to discuss what I had learned in my early career about business management with the students. 


Shortly after beginning in private practice, I was also lucky to find the American Academy of Podiatric Practice Management (AAPPM), where members/speakers are willing to share their business management knowledge. Over time, ...


Editor's Note: Dr. Bass' extended-length letter can be read here.



From: Thomas Graziano DPM, MD


Kudos to Dr. Sol for waking up the elephant in the room if you will. We as a profession have accepted our place in the healthcare arena. We as a profession have been given some crumbs to feed on and accepted them willingly while mainstream medicine, insurance companies, and hospitals continue to consider us outliers. We continue to steer every podiatric student towards a career as a foot and ankle surgeon without regard for their aptitude or skill for the job. Our focus is misguided in my opinion. 


Until we make them physicians first with a well-rounded medical education, their skillset won't match even that of a nurse practitioner or physician assistant. Those who don't have the desire or dexterity for surgery shouldn't be led to believe that they must be surgeons to be "accepted." Recognizing the pedal manifestations of systemic disease is an art in itself and doesn't require one to raise a scalpel in order to reach a diagnosis. Teach the students what it means to be a physician first and give them a legitimate recognized certification so they can fit in once they enter hospital and private practice settings. 


Thomas Graziano DPM, MD, Clifton, NJ



RE: Parity and Basic Medical Skills

From: Nicholas Sol, DPM


This is a period of great change in American medicine, with an array of opportunities and threats. Perhaps the greatest threat to podiatry is that we are unprepared to meet the opportunities to come. We lack some basic medical skills that marginalize podiatry. Medicare was unsuccessful in their recent attempt to marginalize podiatry with lower level E&M codes only for DPMs. We can choose to not be vulnerable. I can think of no other surgical specialty that cannot perform its own admission H&P. Many of my admission H&Ps are performed by PAs and NPs. 


If we are to attain any level of parity, we must possess basic medical skills at least equivalent to all providers. Physical exams for schools, commercial drivers licenses and others are only acceptable if performed by MD, DO, PA, and NP providers. Despite our extensive education and training, DPMs are not included on those provider lists. We all can and should be performing routine head-to-toe physical examinations if we hope to achieve parity. For those without this training, a certification course is available. This weekend certification course is approved by IPMA and Chicago Medical Education Group, and can be given in any state. I urge all DPMs to discuss this with colleagues, attain certification, and make head-to-toe physical exams a routine part of modern podiatric practice. We cannot achieve parity without this basic medical skill set.   


Nicholas Sol, DPM, Colorado Springs, CO



RE: Podiatry College Core Curriculum 

From: Robert Scott Steinberg, DPM


I was talking to a former resident, the other day. Though his son could get into medical school, he wants his son to follow in his footsteps. We talked about the medical courses podiatry students do not receive.


Time is long overdue that colleges of podiatric medicine provide identical courses that medical colleges provide. These should include gynecology and psychiatry, and a few others. Does anyone know which podiatry colleges are already doing this, and which are not? 


Robert Scott Steinberg, DPM, Schaumburg, IL 



From: Sam Bell, DPM


I use Mesa labs and I am satisfied with their service.


Sam Bell, DPM, Schenectady, NY



From: Christopher A Orlando, DPM


I have been using Spore-wise sterilizer monitoring service. It is a very good company. You get a kit to test monthly for one year.  


Disclosure: I have no financial interest in this company.


Christopher A Orlando, DPM, Hartsdale, NY



From: Alan Sherman, DPM


Though I usually agree with what Dr. Elliott Udell writes in this forum, I don’t agree with his assertion that the authors’ credentials should not be identified in scholarly work. Certainly, the work should be judged foremost by the methods used and the evidence presented. But the training of the author, and the institution that they are affiliated with, are important. For example, to the extent that clinical data involving patient care is presented, I’d regard the findings of a DPM or MD clinician above those of a PhD researcher. I am greatly impressed by those who train at great institutions like Harvard, Yale, and Stanford and don’t think it’s an accident that they ended up there.


Yes, in 2019, there still is some bias toward the DPM degree, but in my 38 years as a podiatrist, the amount of bias has gradually declined. Sometime in the hopefully near future, when we are all taking and passing the USMLE and earning the MD degree, the bias will decline even more. But of course, then our path to that achievement will be questioned by those who wish to be biased. There will always be people who respect a person based on their achievements and those who want to put others down. We shouldn’t be distracted by haters and elitists, and continue to improve ourselves and our profession.


Alan Sherman, DPM, CEO, PRESENT e-Learning Systems



From: Ben Pearl, DPM


I like that Dr. Udell Is thinking about the presentation of medical journal articles and inherent bias based on medical or advanced degree of the author. I think there is some value to know what the clinical experience is of the author. For example, a podiatrist would have a lot of clinical experiences to draw on to set up a study design looking at plantar fasciitis. They would be able to differentiate what the natural course of injury is and the time frames that conventional care has benefited their patients. This offers some value in knowing the natural healing progression of the entity as compared to a treatment that is being studied. The vetting process of listing your degree can provide some validation of training, although there are certainly cases of false credentialing. There are pros and cons to both sides of knowing the background of the author.


Ben Pearl, DPM, Arlington, VA



RE: Do U.S. Medical Journals Contain an Element of Bias?

From: Elliot Udell, DPM


Over the weekend, I was catching up on reading some journal articles and after admiring one particular paper, I caught myself looking  at the titles of the authors. I  asked  myself: "what difference should the degree initials after authors' names matter?"


In Europe, medical journals do not list the academic titles of authors. This seems far more fair. Shouldn't a  published paper stand on its own merit irrespective of whether the author has an MD, DO, DPM, DDS, PhD, or any other title after his or her name? Shouldn't readers judge the merit of a research paper based on the evidence presented rather than on the background of who wrote the paper? If a paper has valid evidence and helps us do good for our patients, what difference does it make if the author is a medical doctor, podiatrist, recent college graduate, or even a high school student with a high IQ? Should a research paper mean less to us because of the academic background of who wrote the paper even though the content might benefit patients?


Elliot Udell, DPM, Hicksville, NY



From: Brian Kiel, DPM


Using tube foam, cut alongside to allow it to fit over the hallux. Let the hallux extend through the end of the tube foam. Cut it so it extends proximally past the MPJ about 2-3 inches. Remove the tube foam and in a small bowl pour liquid latex over the tube foam and work it into the tube foam so it is soaked. Place on the hallux, cover with a plastic bag and then place the sock and shoe on the foot. 


Make your own latex bunion shields.


I tell patients to keep the shield on until bedtime and then gently loosen and suspend it on a pencil so it does not lie flat. The next day, they bring it in and I re-soak it in latex. Once this has dried, you can trim any excess off. If you want a thicker bunion shield, add a third dipping. I have had patients use these for several years. 


Brian Kiel, DPM, Memphis, TN



From: Martin V. Sloan, DPM


Whenever cost of medication becomes an issue with my patient, I pull out my smartphone and go to the “GoodRx” app, click on it, and show the patient the options. Four or more pharmacies will pop up in your area with their coupon prices, usually SIGNIFICANTLY lower than what you’d expect. The app is free and available to everyone. 


Martin V. Sloan, DPM, Rockwall, TX



From: Jill Berkowitz-Berliner, DPM


Are you talking about the brand name drug or including generic terbinafine? The generic used to be on the $4 co-pay list at Target. When CVS bought Target, it went up to $5. As of 1/1/19, it is approximately $64, but with the pharmacist gag rule repealed, the pharmacist can use a coupon, making it approximately $24, according to one of my patients. 


Jill Berkowitz-Berliner, DPM, Mount Kisco, NY



From: Alan Sherman, DPM


I am interested in the issue that Dr. Silhanek raises regarding the limitation that some states impose on earning CME online or in print, and agree with her, that we should all be allowed to earn our CME in the most convenient and effective manner. Whether that be live or online will depend on the person. Although I do own and run PRESENT e-Learning Systems which delivers over 20,000 CECHs annually, as we run both live conferences and offer online CME, I have two dogs in this race and wish that both could win.


Most of all, I believe in freedom of choice and do object to states limiting how much credit is permitted to be earned online. Polling done by Barry Block and us clearly shows that podiatrists want freedom to earn their CME in that way that they feel provides the most convenience and effective learning. Having this data, why are the states still resisting? We should all make our opinions known to our state associations and boards of podiatry to get these regressive regulations changed.


Alan Sherman, DPM, CEO, PRESENT e-Learning Systems



From: Alison Silhanek, DPM


I have been thinking more about this.

1) I realize that the organizations that hold these conferences think they rely on the revenue generated by attendees. But here’s the thing: if they hired videographers to record the lectures and panel discussions, had the lecturers each create a short test that would confirm the viewer actually watched the lecture (like Podiatry Management does with its online CME articles) and charges a reasonable fee to take the test and thereby gain the CME credits, those organizations are gaining a revenue stream from podiatrists that they might not have otherwise reached. It’s a “win-win”. 

2) I don’t know how we would work to change the rules of the various state education departments. I’m just suggesting that, if many people agree with this idea, maybe our state and national organizations should try.

3) Regarding Dr. Steinberg’s reply, I have great respect for his opinion, but I do not see conferences as having much social benefit (for me) anymore. As a solo practitioner, if I have to shutter my office for a week, I would rather spend that week exploring the temples of Cambodia or the coastline of Croatia, but that’s just me. And then I would prefer to get my CME credits at 2 am sitting on my couch in my PJs. But his points are well taken as that might just be my own preference.


Alison Silhanek, DPM, Smithtown, NY



From: Jeffrey Kass, DPM


Dr. Silhanek makes some excellent points regarding “CME in the 21st century”. One possible mistake in the posting was the statement “we, as are all physicians, are regulated to participate in a specific number of CME credits per year.” Once again, podiatrists are not considered physicians in this realm. In NY, podiatrists must log 50 credits per three years to renew their license (maximum of 25 home study). MDs in New York do not require any CMEs in New York.


This, in my humble opinion, should have been used as part of the podiatrists' argument for expanded scope. Podiatrists with their limited anatomy are always staying current, whereas MDs with a broader license don’t have to. Hence, the MD may not actually be up to date on advances in medicine.


I agree with Dr. Silhanek that one should be able to obtain all CME online if they so desire. There is no reason in the 21st century that one should have to pay for flights, hotels, etc. if they don’t want to. I am curious as to who sets the state rules for CME credits? Is this the Board of Podiatry for the particular state? 


Jeffrey Kass, DPM, Forest Hills, NY



From: Robert Scott Steinberg, DPM


At the CME meetings I attend, there are multiple tracks going on at the same time. I do not see how Dr. Silhanek knows who does or does not attend lectures! Getting together with colleagues should not be dismissed. I am not a fan of online CME. Oh sure, it's easy, maybe far too easy. Yes, it is cheaper. What I think is more problematic is the money being taken away from state associations when someone pays to attend non-member organizations' CME - part of what helps to keep our dues down is the money that comes from state association-sponsored conferences.


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Bret Ribotsky, DPM


I believe that Dr. Silhanek brings up an interesting discussion that we all need to entertain. A very common thought is that the purpose of obtaining credits is to maintain licensing and to keep privileges, while the truth is why we all need credits is to continue our knowledge, so that we can practice medicine at the highest level possible. We all have seen many who just show up to get the badges scanned. Whose fault is this? Should we blame the seminar for not having speakers charismatic enough to pack the room, or should we blame the state regulations for requiring so many credits each year?  


Do we really need a sales pitch on an expensive treatment with zero new research on onychomycosis, or a lecture from a politician (with no published research) who secured a position on a speakers bureau. To me, it's crystal clear who is to blame, and it’s the person you see each day in the mirror.  


The 21st century cure is something all should participate in. The seminar should have speakers and information that delivers incredible value. The attendees should be responsible for being in the room learning and this can be monitored via GPS and smartphone technology available. States should not judge CME by hours, but by content needed each year for practitioners to master. I can dream. 


Bret Ribotsky, DPM, Boca Raton, FL



RE:  CME in the 21st Century

From: Alison Silhanek, DPM


As I endeavor to collect my CME for hospital recredentialing, I have begun to re-evaluate the entire experience of CME. Specifically, the cottage industry that promotes “live” CME. I see this question as generational. After being in practice for 20 years, I fully see the value of not only CME but live workshops for certain learning experiences— surgical, biopsy, etc.


But we, as are all physicians, are regulated to participate in a specific number of CME credits per year. In my state of NY, it is required that a hefty percentage of those hours be live. I question this. To be frank, these conferences cost a lot of money; the same lecturers show up every time and those speakers end up benefiting in the long run more than attendees. (If you are a regular speaker and disagree, so be it.)


More importantly, most attendees at these live conferences skip the lecture and show up to have their badges scanned to get credit. At least with online courses (like those offered by Podiatry Management), one actually has to read the article and take an exam to get credit. Can’t physicians enter the 21st century already?


Alison Silhanek, DPM, Smithtown, NY



From: Richard M. Cowin, DPM, JD


I highly recommend the Facial Plastics Camera from The cost is $795. We utilize a label maker to print the patient's first initial, last name, and the date. We attach it to the foot and take the photo(s) which are stored on an SD card. We then remove the SD card from the camera and upload the images to the patient's EHR record. 


Richard M. Cowin, DPM, JD, Orlando, FL



From: Donald R. Blum, DPM  


I think that you will need to visit with your EHR vendor. E clinical Works (ECW) has a mobile app that allows the provider to see the office schedule, dictate, and take pictures with a smart phone. The picture is not stored in the smart phone, nor is it stored in the office computer, but it is directly uploaded to the patient's record for that visit date and stored in the cloud. 


If the photo is stored in the device and the patient and photo are related, there could be a HIPAA issue if there is unauthorized capture of the information.


Donald R. Blum, DPM, JD, Dallas, TX



RE: TayCo External Ankle Brace (Frank DiPalma, DPM)

From: Dennis Shavelson, DPM


I have been working with the inventor and the orthopedic surgeon associated with the TayCo Brace (the first patented AFO that lives outside of the shoe instead of inside the shoe) for about 7 months. It is truly a game changer for many CAM walker, AFO, and custom foot orthotic applications. It was originally developed by Mike Bean, an associate athletic trainer at the University of Notre Dame for inversion ankle sprains (players are back playing football and basketball in days rather than weeks).


Think of this brace as an external, temporary, frontal plane stabilizer plus a subtalar arthroereisis procedure all in one. It is measured and fabricated to the patient's shoe and leg (no casting). Since this brace has no foot plate, it can be used in combination with an OTC or custom foot orthotic, especially when additional rearfoot control, vaulting or forefoot control is necessary as a part of care such as in PTTD, flexible juvenile flatfoot, and fall prevention.


Disclosure: I am a biomechanical consultant to TayCo Brace.


Dennis Shavelson, DPM, NY, NY



From: Jack Ressler, DPM, David Zuckerman, DPM


I'm not sure what your parameters are for disposable nail nippers but the company called TRIM, which provides many manicure and pedicure products, makes curved nail nippers that work great. They are under $9.00 and can be purchased at Target. The spring mechanism is a poor design but should last for several months. If any manufacturer of quality nail nippers reads this query, please buy one of these and replicate it. The size and function is the best I have used!


Jack Ressler. DPM, Delray Beach, FL


I am one of the exclusive distributors of disposable nail clippers.


David Zuckerman, DPM, Cherry Hill, NJ 



From: Ira Baum, DPM


I find the concern regarding payment disparity a sad topic. It’s sad because podiatrists have been fighting this issue since the beginning of managed care and nothing has changed for the better. Reading the post made me think that it’s just another generation of podiatrists learning that our profession, as noble as it is in the minds of third-party payers, has a value that can be deeply discounted. Unfortunately, most patients accept our financial value, even when we perform limb-saving treatments. The courts have not been kind to us and have indirectly enabled insurance companies to continue to discriminate against equal pay for equal service. Maybe the new generation will have success in fighting this obvious inequity.


Ira Baum, DPM, Naples, FL