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12/27/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Payment Disparity Between DPMs and MDs


From: Jarrett Hamilton, DPM


 


12 years ago, I was fresh out of residency and chose to join a multi-specialty group. As part of the credentialing process, my new group was trying to get me on the Humana panel in our community. At first, I was told flat out “we have enough podiatrists. We don’t need/want you.” -  to which our group said all or nothing! (Meaning they threatened to pull all the other physicians in our group if I wasn’t credentialed).  


 


Humana caved in and tendered me a contract. Unfortunately, the contract tendered was at below Medicare rates of reimbursement (All the doctors in our group got 115% of Medicare from Humana). So once again, our CEO said, "if you want any of our doctors, you will pay all of them at 115% of Medicare." They once again caved in to our demands. To me, this experience highlighted the need to be part of a larger organization early on in a career.   


 


Jarrett Hamilton, DPM, Sierra Vista, AZ

Other messages in this thread:


02/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Hartley Miltchin, DPM


 


They have discontinued the foot moisturizing cream because of poor sales in the foot category.  The CeraVe SA cream used on other parts of the body is the exact same formula.


 


Hartley Miltchin, DPM, Toronto, Canada

02/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: ABPM Non-Recognition of Residencies (William E. Chagares, DPM)


From: Daniel Chaskin, DPM


 


GME funding is linked to the fewest years needed for the certification process. Why can't such funding co-exist with an additional alternate path of 30 years' or 20 years’ experience in practice? The public is hurt by excluding qualified podiatrists from board certification with the experience and the knowledge to pass a certification exam. This would be a win-win situation for all experienced podiatrists who never got a residency match.


 


Daniel Chaskin, DPM, Ridgewood, NY

02/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Supna Reilly, DPM


 


The enPuls unit is extremely effective and has been a wonderful source of revenue for our office. We do 6 treatment sessions spaced 2-3 days apart, and charge $100/session. Literature suggests the efficacy of shockwave to be around 80%, and we have found that to be the case in clinical practice as well. It tends to be an easy sell for patients who don't want to go the surgical route or have plateaued in their progress. The customer service on the unit is also unparalleled. I recommend this unit.


 


Supna Reilly, DPM, Chicago, IL

02/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Kevin A. Kirby, DPM


 


The “Pose Method” and “Chi Running” are styles of running popularized over the past decade where coaches teach runners to try to land more on their forefoot, and not on their heels, during running. These two running “methods” were created by individuals who have sold books, produced videos, and have trained coaches to teach runners on “the proper way to run”. Neither of these running methods, which have likely made their creators lots of money, have been shown to be more “natural”, more metabolically efficient, or less injury-producing than other running styles.


 


Pose and Chi running became popular during the barefoot running fad of 2009 to 2015, where many self-proclaimed “running form experts” on the Internet asserted, without supporting scientific research evidence, that...


 


Editor's note: Dr. Kirby's extended-length letter can be read here.

02/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Stephen Kominsky, DPM


 



The last few words spoken by [Dr. Jacobs'] patient have been my mantra for the 37 years that I have been in practice. Instead of the APMA producing Johnny Sorefoot Balloons and the like, I have always felt, and feel even stronger today, that it is an absolute MUST that the “lay-public” be educated about what a podiatrist can do. For someone in this day and age to ask a podiatrist that question is a "Shonda" (Yiddish expression meaning something terrible).


 


Just like the AMA has done a miserable job on educating the public about the declining reimbursement, we have done a poor job regarding our education and abilities. We MUST be better at telling everyone what a podiatrist can do, and do it better than anyone else, or we will not survive. 


 


Stephen Kominsky, DPM, Washington, DC


02/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Alan Sherman, DPM


 


Dr. Allen Jacobs in a recent letter said, “I was evaluating a post-op Austin-Akin patient today. She told me that she watched the (My Feet Are Killing Me) reality show. Her exact words were; “I’m impressed. I had no idea podiatrists did such complicated things.” This just goes to show you how different a patient’s perspective can be from a physician’s. I’m wondering what she saw on the show that seemed more complicated than the intricate surgery that she had done by Dr. Jacobs. Maybe she meant, “unusual” or “serious” or “rare” or “bizarre”, but complicated? We should all be more aware of how different a patient’s perspective can be from our own.


 


By the way, keep an eye out for media segments that Drs. Ebonie Vincent and Brad Schaeffer did on the Dr. Oz Show, TMZ, DailyQ, Good Day, and recently, they filmed a segment for the Tamron Hall Show which aired on Friday at 1PM. These two podiatric reality superstars have been quite busy talking up podiatry to a huge national audience.


 


Alan Sherman, DPM, Boca Raton, FL

01/31/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Allen Jacobs, DPM


 


“Although lasers are approved by the FDA for onychomycosis” is not entirely correct. The FDA states that lasers may be used as adjunct therapy to supplement accepted management protocols for the treatment of onychomycosis. In fact, the FDA published policy on the matter advises not to claim that lasers are a cure for onychomycosis, but provide only temporary improvement in the appearance of the toenail. At-risk populations in which the treatment of onychomycosis is considered necessary (e.g.- diabetics, PAD patients, immunosuppressed patients) are denied appropriate treatment when lasers are employed, while subjected to potential risks.


 


The FDA approved the safety of lasers, not the specific employment of this modality for onychomycosis. And yes, while speciation is not required as lasers are not “species specific," some confirmation of fungal infection would seem appropriate prior to treatment.


 


I was evaluating a post-op Austin-Akin patient today. She told me that she watched the show. Her exact words were; “I’m impressed. I had no idea podiatrists did such complicated things.” 


 


Allen Jacobs, DPM, St. Louis, MO

01/31/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A


RE: My Feet Are Killing Me Cable Series


From: Keith L. Gurnick, DPM


 


To all of us who are watching or will watch the new show made for TV, "My Feet Are Killing Me" Cable Series, please understand that this is a made for TV show and is for the purpose of  entertainment to viewers. Don't expect to see on television that every patient is greeted, examined, diagnosed, and treated as if you were their doctor in your practice or office. Patients for these types of shows are cherry-picked for various reasons, and filming is edited down to produce a final product without  doctor involvement. 


 


Do not assume that what you see on TV is the full extent of the treatment. Do not expect many of the patients to exhibit the problems that most of us encounter. These might seem to the TV audience to be extreme and often include unusual back stories for the patient or their families  to make the show more interesting. 


 


Keith L. Gurnick, DPM, Los Angeles, CA

01/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From:  Timothy P. Shea, DPM


 


Like other podiatrists, I have been interested in, and pleasantly pleased, by the presentation of podiatric medicine and surgery on this series. These young podiatrists present a very pleasant, personable, and professional image of our profession. This can only help to promote our image in the public arena. I know we can be a little nit-picky about topics and credentials, but recently I was approached by the chief of medical staff at one of my local hospitals about the program. He and his wife (a physician) also watch it and enjoy it very much. The key point he made to me about this series is that it presents interesting cases and good information to the public about foot and ankle care. That was a real compliment. Kudos to the stars of this show.


 


Timothy P. Shea, DPM, Concord, CA

12/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Alan L. Bass, DPM


 


I highly recommend Mike Crosby of Provider Resources, LLC. Mike has been around podiatry for many years. He provides high quality evaluations of practices. I have worked with him on a number of occasions to help clients I know to either sell or acquire practices.


 


Alan L. Bass, DPM, Manalapan, NJ

12/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Importance of Keeping up with New Medicines


From: George Jacobson, DPM


 


It is important to look up medications that you are unfamiliar with. I had a new patient who was on Truvada. Many medications have similar names. Truvada, a combination of the antiretroviral drugs tenofovir and emtricitabine, is the only FDA-approved regimen to be used as pre-exposure prophylaxis, or PrEP, against HIV. How many of us knew that medication and its indications? 


 


George Jacobson, DPM, Hollywood, FL

11/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Chris Seuferling, DPM


 


I agree with Dr. Alan Sherman's comments. In addition to biomechanics, I would add wound care to the list. In Oregon, we are trying to pass a scope bill that would allow podiatrists to treat venous stasis ulcers up to the level of tibial tubercle. During my research to gather supporting documentation to "prove" our expertise in this area, I was disappointed to find that there is nothing specific in CPME 320 regarding treatment of venous stasis ulcers, only vague generalizations. The level of training in wound care and particularly venous ulcers varies from residency to residency. This makes it difficult to convince MD/DO associations and legislators that we are "experts". 


 


I fear we are going to lose our "podiatric" identity unless we assess and standardize our residency programs to include essential elements that define our specialty.  Otherwise, podiatry will evolve solely into a backdoor route to becoming orthopedic foot and ankle surgeons. This may be okay for some, but I believe the essence of podiatry offers so much more than that to patient care and to the medical community.


 


Chris Seuferling, DPM, Portland, OR

11/28/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Gary S Smith, DPM


 



I came across advertisements from the late 1800s for snake oil and I was struck by the almost identical claims of cure by CBD oil dealers. I heard CBD oil repels giant emu attacks so I keep a bottle in my office. It works too! I haven't seen one emu!


 


Gary S Smith, DPM, Bradford, PA


11/27/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Source for CBD Oil (Jack Ressler, DPM)


From: Robert Kornfeld, DPM


 


The best medical grade CBD oil I have found comes from Canbiola, Inc. 


 


Disclosure: I am on the medical advisory board of Canbiola.


 


Robert Kornfeld, DPM, NY, NY

11/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven Selby Blanken, DPM


 


The point people miss with the name plates is that the title of all the representatives always says “Dr., Mr., Ms., Miss, or Mrs.” Name plates don’t show the degree for anyone. I’m surprised by Dr. Jacobs’ comments that may have been interpreted in a negative tone by some about Dr. Wenstrup. I am so proud of Dr. Wenstrup. I have met him and hope he is President one day. I also feel Dr. Jacobs has been a great icon in our profession.


 


Steven Selby Blanken, DPM, Silver Spring, MD

11/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Bill Beaton, DPM


 


I use DoctorDefender.com which is not a collection agency, but a collection tool that is more effective and far more affordable than collection agencies. I designed the system and had it built several years ago to help solve my personal patient collection issues and when I saw how well it worked for me. I decided to share it with other providers as an add on service through my partner's billing company, PracticeDefender.com. After two billing statements, I send a DoctorDefender notification letter for best results.


 


Disclosure: I am co-owner with PracticeDefender.com


 


Bill Beaton, DPM, Saint Petersburg, FL

11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: OH Podiatrist Shines at House Intelligence Committee Hearings


From: Burton J. Katzen, DPM, Bret M. Ribotsky, DPM


 


Hats off to Congressman Dr. Brad Wenstrup for being such an eloquent representative of our country and our profession.


 


Burton J. Katzen, DPM, Temple Hills, MD


 


While I know very few PM News readers have the opportunity to be watching the hearings of the House Intelligence Committee on TV this week (and last week), I just want to report something no news media is reporting. Our own representative, podiatrist Brad Wenstrup, DPM, is clearly making all of us very proud. His name plate says “Dr.” and his questions have all been very thought-out, probing, and a clear demonstration that he is well learned on the subject. All DPMs should be proud of the voice we all have in Congress, and we can only hope that Brad wishes to continue to stay in Congress, as it’s clear he has the respect from both-sides. Once again, we should all be proud of our 2018 PM Podiatry Hall of Fame inductee.


 


Bret M. Ribotsky, DPM, Boca Raton, FL

11/20/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Allen Jacobs, DPM


 


The question of biomechanics/kinesiology education in podiatry is an important one.


Some observations:


1. Residents with whom I speak tell me that it is distinctly uncommon to see gait analysis performed on most patients, including those being evaluated for surgical intervention;


2. As an ABFAS reviewer, I can tell you that a detailed documented weight-bearing examination is typically not present;


3. The overwhelming number of journal publications in the area of biomechanics are by professionals other than podiatrists;


4. Most biomechanics education at CME programs is corporate supported, and lectures are biased toward the products distributed by the corporation providing the grant or speaker;


5. There is too much reliance on radiographs in surgical decision-making when such data cannot be interpreted in a vacuum;


6. Gait analysis must include requisite knowledge of interrelated factors such as neurology and pathology above the foot and ankle;


7. Too many unproven and edgy theories, always product driven, are allowed to be presented at CME meetings; it is another example of so called scientific directors of programs allowing the “pay and you can play” construction of CME programs. Students and residents know what they see. What they do not see is the incorporation of serious biomechanics/kinesiology evaluation in patient care. Until they do, a minimal appreciation and application of these sciences will continue to be relegated to the status of a rite of podiatry passage no more considered in daily practice than the Krebs cycle.


 


Allen Jacobs, DPM, St. Louis, MO

11/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Shortage of PMSR/RRA Programs (Daniel Chaskin, DPM)


From: Charles M Lombardi, DPM, Alan A. MacGill, DPM


 


First, Dr. Chaskin is in error on several fronts. Most programs are PMSR/RRA. Second, it is only select states (that used the unified residency training model) in which one cannot do leg soft tissue procedures. 


 


Charles M Lombardi, DPM, Flushing, NY


 


According to the 2020 CASPR Directory, nearly all of the podiatric residency programs in the country are PMSR/RRA with the exception of only 9 programs.


 


Alan A. MacGill, DPM, Boynton Beach, FL

11/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Time for The New Generation of Podiatrists to Speak Up


From: Dale Feinberg, DPM


 


I’ve followed PM News for quite some time and noticed that there are only a limited number of practicing podiatrists who are either proactive or reactive to the many subjects brought up on the open forums. If you read their current posts, it appears that many are about to hang up their white coats. I can’t believe that out of over 18,000 daily subscribers, the new generation is not stepping up to let us know what they think. 


 


When I was editor of the First Amendment at the California College of Podiatric Medicine, I was tasked with editing, writing, layout, and publishing 95% of each issue. I guess things haven’t changed much in the last 40 years. Please step up and help Barry keep this blog going. He needs new blood and he needs our help. To post a comment or respond to one, simply reply to PM News or send an email to bblock@podiatrym.com.


 


Dale Feinberg, DPM, Yuma, AZ

11/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Robert Kornfeld, DPM


 



This discussion is a critically important one, especially because my professional path brought me to a deep understanding of human physiology, the foundations for health and healing, and a never-ending focus on understanding mechanisms of pathology BEFORE symptoms are treated. I pursued a path in functional medicine for foot and ankle pathology because it provides a means to heal pedal pathology AND improve the health of the patient. This has been my path and my passion since 1987 (I am a 1980 graduate of NYCPM). My career has been extraordinarily satisfying because the healing is in medicine, not surgery. Of course there’s a place for surgery, but without a true mechanistic approach to healing, we correct one issue but leave our patients open to future pathology.


 


Podiatry has always struggled with itself. In our zeal to be accepted as ”real doctors”, we focused on pushing ourselves into hospital operating rooms. Unfortunately, that...


 


Editor's note: Dr. Kornfeld's extended-length letter can be read here.


11/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Brent D. Haverstock, DPM


 


It would seem that if podiatry is to become a branch of medicine (MD/DO), the APMA would have to meet with the American Medical Association (AMA) and the American Osteopathic Association (AOA) to see if there is a desire to see this happen. If there were an agreement, the schools of podiatric medicine would have to close. The APMA and AMA/AOA along with the Accreditation Council for Graduate Medical Education (ACGME) would establish appropriate training programs.


 


I suggest a 5-year commitment to become a podiatric surgeon and 3-years to become a podiatric physician. Podiatric medicine and surgery would have a single certification board with specialist certificates granted as either a podiatrist or podiatric surgeons. Medical students (MD/DO) could consider podiatry or podiatric surgery as their career path. This is the only way to...


 


Editor's note: Dr. Haverstock's extended-length letter can be read here.

10/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Leonard A. Levy, DPM, MPH


 


In the ongoing discussions about the highly controversial proposal to have two specialty boards in the podiatric medical profession (i.e., podiatric surgery and podiatric medicine), Ira Baum, DPM remarks, “Unfortunately, it is the grassroots podiatrists who will suffer for their inaction. I strongly recommend those in leadership positions to consider these points and begin to explore options and opportunities for change”. 


 


James J DiResta, DPM, MPH further states that, “Many graduating podiatric medical students would benefit from an Intensive Podiatric Medicine Residency option. Providing this option for our graduates who do not want to be surgeons can have real value IF done correctly. That would work if we were able to engage Dr. Levy in this process in creating such a program.” 


 


I suggest that the best way to address these and related matters is to engage in major strategic planning and include leaders in the profession to once and for all determine the direction of this growing, exciting profession. As said in Alice and Wonderland, “If you don’t know where you are going, how will you know when you get there?” Certainly if it was thought I could help, as Dr. DiResta hints, I would be glad to do so at any level.


 


Leonard A. Levy, DPM, MPH, Ft.Lauderdale, FL

10/26/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Jon Purdy, DPM


 


There is no need to compare dentistry to podiatry in this debate. Dentists are not defined as physicians nor do they have any competition among the medical community. Our closest colleague and competitor, orthopedics, has gone through its own transitions over the years. Originally a specialty in addressing pediatric deformities (the Greek derivation meaning “straight babies”) has transitioned to anything bone related in all age groups.


 


I find it a difficult argument to claim three years of residency isn’t a sufficient amount of time to learn the surgical and medical conditions related to the lower extremity. Orthopedics learns the surgical and medically related treatments of the entire body in four years. The first of five years concentrates on general surgery and medicine. Once an orthopedist’s standardized residency is completed, they may choose to do additional training in specialized areas or concentrate their practice on specific areas of their basic training.


 


Change is inevitable and our profession has not kept up. It should be obvious at this point, an MD degree will be our only acceptance into the medical world, fair or not. Aside from that, not having standardized training in ALL aspects of lower extremity care, and one single certifying board, is foolish, to say the least.


 


Jon Purdy, DPM, New Iberia, LA

10/26/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Leonard A. Levy, DPM, MPH


 


Elliot Udell, DPM, asks a great question, namely, “Could you offer us some insight into why podiatry has not generated the types of limited specialty practices that we see in dentistry and medicine?” I served a total of 14 years as dean and then president of the then California College of Podiatric Medicine. For another 14 years, I was founding dean of the College of Podiatric Medicine and Surgery of the then University of Osteopathic Medicine and Health Sciences (Des Moines, Iowa). I just spent 17 years as associate dean of the Nova Southeastern University (NSU) College of Osteopathic Medicine learning in detail the intricacies of a DO curriculum. I just completed a year serving of the curriculum committee of NSU’s new allopathic medical school and currently serve as an interviewer of applicants to that school.


 


I was successful in modifying the pre-clinical aspect of podiatric medical education at the California and Des Moines podiatric medical schools and led the way in California to a podiatric medical residency that was 2 years in duration, virtually unheard of at that time. But the profession for years kept focusing on preparing DPMs who were qualified podiatric surgeons. While vital, it is time to expand that narrow perspective and provide graduate medical education that leads to the production of highly qualified podiatric physicians comprehensively training, experienced, and certified in the relatively neglected area of medicine related to the pedal extremity.


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL
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