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03/19/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC)


RE: Podiatrists and COVID-19 Pandemic


From: Janet Kail, DPM


 



Has anyone addressed whether it is advisable to continue seeing non-emergent patients in our offices?  So far we are still seeing patients but for the health and safety of all (doctors, staff and patients), what is the opinion of everyone about keeping our private offices open during the COVID-19 crisis)?


 


Janet Kail, DPM, Fairborn, OH


Other messages in this thread:


04/09/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC)


RE: Doxy.me Telemedicine Platform


From: Eddie Davis, DPM


 


The move to telemedicine has been hastened by the recent emergency rules created during the COVID-19 crisis. PICA has included information about liability coverage for telemedicine visits in a recent webinar and made a televisit consent form available. There are many companies offering telemedicine programs. We started using a subscription service, Doxy.me, last week. It seems effective, inexpensive, and simple to use.  


 


One conspicuous feature absent from Doxy.me and other platforms is the ability to record the visit. So far, I am uncertain as to why that is the case and request feedback from anyone who may know why. It should not be an issue of technology.


 


Windows 10 includes the Windows Voice Recorder program. If your version does not have it, download it from the Microsoft Store online. Pin the application to your start menu or create an icon so you can toggle it on and off. It creates an MP4 file which could be uploaded to a number of EHR programs. I do not know if there are medicolegal reasons not to use this. I have constructed a telemedicine template for my EHR but would welcome suggestions and compare notes on the best way to make this template.


 


Eddie Davis, DPM, San Antonio, TX

04/08/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 2



From: Bryce Karulak, DPM


 


I cannot agree more with Dr. Sokoloff. I hope California is successful in their quest to pursue a plenary license to practice Medicine. When NPs in Texas attain an unrestricted license (only a matter of time), I will sit back and consider going back to school unless there is a shorter alternative such as a year of training/practice in general medicine to appease those with concerns.


 


I don't know if there will ever be a consensus of podiatrists who would approve a plenary license and I think we should consider subdividing ourselves (yes again) to those who seek or, at some point, have a plenary license and those who do not wish to practice that way. This is the way that the ABFAS has Foot and RRA certification; and if you have a plenary license, you can always choose not to practice every aspect of it. After all, that is what medicine does with its sub-specialties. 


 


Right now, we burden future podiatrists with a residency training that goes well beyond our scope of practice and all it does is "Wow" those MD/DOs with our knowledge. Unfortunately, at times, it is disregarded and assumed by medicine that it was not a true residency. I speak from experience going through the credentialing process 4 times in 3 years at the same institution and now serving on the Credentialing Committee at that same institution.   


 


Bryce Karulak, DPM, Fredericksburg, TX

04/08/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1


RE: Reducing Expenses During the Pandemic 


From: Lancing Malusky, DPM


 


While we are all "sheltering in place" with family, a 2 or more car family only needs one car for groceries, etc.  Your insurance expense can be greatly reduced by calling your agent and have any unnecessary vehicles placed in storage. This suspends your collision and liability, but theft is still covered. A simple call to your agent can put a vehicle in or out of storage at any time.  


 


Lancing Malusky, DPM, Kettering, OH

04/07/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 2



From: Paul T Slowik, DPM


 



The impact of COVID-19 is nothing like anyone expected and puts an overwhelming strain on our healthcare system and professionals. As physicians, we are called to care for the needs of our patients. We took an oath to take care of the whole patient, not just their feet and ankles. In a way this crisis presents an opportunity for us to demonstrate our medical acumen, our superior knowledge of sterile and aseptic technique, and our abilities to accurately monitor patients in totality. By working side-by-side with other physicians and mid-levels, these skills will become self-evident. Parity will not come by demanding an MD or DO degree, but by demonstrating by our skills that we indeed are physicians working with our colleagues in the trenches.


 


In my state of California, California Health Corps is an organization where healthcare professionals can volunteer and be placed in areas of need. The application is available online by Googling “California Health Corps”. You will be paid and malpractice insurance will be provided. I recommend for those in other states, to check what opportunities you have for volunteering. If you want parity to be known as a physician, behave as one.


 


Paul T Slowik, DPM, Encinitas, CA  


04/07/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B



From: Vincent Gramuglia, DPM


 



I could not agree with Dr. Sokoloff more. I am perplexed by individuals who in the middle of a disaster feel that is an appropriate time to discuss such ridiculous nuances. These individuals are volunteering their time and they will perform to the level of their competence. Maybe they’re just monitoring patients and maybe they are getting elbow deep in their medical care. What difference does it make what rotations they had or what experience they have in these situations? Aren’t police officers who apply tourniquets to bleeding limbs or deliver babies on the highway also in over their heads? We’re not talking about an elective case in a surgery center right now; we’re talking about an unprecedented global disaster.


 


Having said this I will never understand what prompts certain individuals at moments like this to criticize the selfless actions of others. These residents are true doctors, not paralyzed by their insecurities, who likely are more equipped to provide these services than 80% of dermatologists, ophthalmologists, orthopedic and plastic surgeons. I am privileged to work alongside these remarkable people and I take offense to those who succumb to the absurdity of their pet peeves.


 


Vincent Gramuglia, DPM, DVA NY Harbor 


04/07/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A



From: David Armstrong, DPM


 


I wholeheartedly agree with Dr. Sokoloff’s comments vis a vis the evolution of our specialty. We are one of the few (if any) specialties that seems to want to “pre-credential” itself. We seem to draw odd anatomic Mason-Dixon lines at obscure joints. We have many different boards for the same anatomy. We really need to stop this. It is, frankly, slightly embarrassing. Podiatric surgery is a surgical specialty in the USA. There may be a spectrum of surgical activity - like in any surgical specialty. However, we need to consolidate in this peri- and post-pandemic era. 


 


We should leave credentialing to the hospitals and base it on our surgical experience and training— like in any other specialty. I see this happening more and more, which is heartening. We should also team up to do our part to a) keep folks out of the hospital during this unprecedented time and b) dive in to help care for inpatients if we so choose. Here’s to Dr. Theodoulou and Dr. Sokoloff and the others who have trained and continue to train the next generation of men and women focused on helping people move through the world a little better.


 


David Armstrong, DPM, Los Angeles, CA

04/06/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 3



From: John Chisholm DPM


 


I respectfully disagree, Dr. Mozena. The degree doesn't matter. It's the license that matters. Each state licenses podiatrists (DPM degree) differently. Some have an expansive scope; others are much more limited. But they all have the same thing in common - all 50 states currently restrict the license to practice podiatric medicine to some anatomical area of the lower extremity. 


 


In California, we are trying to change this. We are attempting to change the license to practice podiatric medicine from a limited license to a full, unrestricted, plenary license, so that MD=DO=DPM. In this way, we will retain our DPM degree yet will be able to practice to the full extent of our education and training, like other MD and DO specialists. 


 


As for being grandfathered into an MD or DO degree...there has been unqualified opposition to this from those who will be doing the grandfathering - the MDs and DOs. 


 


John Chisholm, DPM, Chula Vista, CA

04/06/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1


RE: Potentially Devastating Effect of COVID-19 on Podiatric Medical Practices


From Leonard A. Levy, DPM, MPH


 


Minimal information is in the press about the effect of COVID-19 on health professional practices, especially their economic well-being and even the contemplation of closure. Patients are not showing up for appointments and cancelling non-urgent visits. It is reported that hospitals are cancelling elective procedures, a significant source of income for orthopedic surgeons, cardiologists, and gastroenterologists. This has escalated dramatically in the second half of March.


 


What has not been discussed is how it may be affecting podiatric medical practices. A major symptom of how healthcare practices are slowing down is the significant drop-off of claims at health insurers. Because of increasing concerns, actions designed to keep practices viable have been compiled by...


 


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

04/03/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1


RE: Podiatrists' Role in the Coronavirus Panademic


From: Michael H Theodoulou, DPM, John Mozena, DPM


 


The role of a podiatrist during the coronavirus pandemic has nothing to do with current training, education, or state scope of practice. It has everything to do with the individual institution where one practices and the credentialing process. As current chief of our division and surgical representative to the credentials committee, the advancement of credentials to even our allopathic and osteopathic colleagues who have plenary licenses, goes through significant scrutiny as we deploy providers during this period of crisis. Suffice it to say, it is not the Wild, Wild West where anything goes.


 


We have a pandemic that is producing enough harm. Let us not promote ourselves to a level of incompetence just because we performed a few intubations during a two week anesthesia rotation as a resident five years ago. At least in our system, where we are emergently advancing credentials and roles to address shortages, there must be adequate basis to extend this to the provider, regardless of the letters behind their name.


 


Michael H Theodoulou, DPM, Somerville, MA


 


Isn’t it time we stop this DPM degree nonsense! We are residency trained physicians who are being underutilized. I’m watching NPs, PAs, nurses, and other health professionals doing wonderful work during this crisis with much less training than we have, and yet many of us are sitting on the sidelines because of the restrictions placed on our license. Grandfather us into a DO or MD like they did to the DOs back in the 60s in California. Our time has come! I thank the APMA trying with their letter to states, but the degree matters!


 


John Mozena, DPM, Portland, OR 

04/02/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC)



From: Bryce Karulak, DPM 


 


I truly appreciate my colleagues stepping up and practicing what they preach. I also appreciate that APMA has released a position for our role. This is our time to do what is right and to treat humanity. We can show that we are a critical part of medicine and that we are equals.  


 


Those who participate in treating these patients are truly putting their lives on the line and practicing what medicine has asked of us. I have already sent the APMA statement to my hospital and my respective state APMA component. I hope that all of you will do the same. We have an obligation to do what is right; so, let’s act on it.  


 


Bryce Karulak, DPM, Fredericksburg, TX

04/01/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 2B



From: Clifford Wolf, DPM


 



I spent five months of rotations on varying types of medicine. One of those months was with critical care, where we managed patients on vents. I also did a month of anesthesia, again with vent management. 


 


For the purposes of transparency and with no disrespect meant, what rotations and for how long did these residents participate that you believe they are qualified to act as first responders?


 


Clifford Wolf, DPM, Oceanside, CA


04/01/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 2A



From: Jeffrey M. Robbins, DPM


 


I want to take a moment to also highlight four of our podiatric residents from the New York Harbor VAMC, Drs. Jacob Mechlowitz, Danielle Du Bois, Ashley Kim, and Joseph Schmidl who have all volunteered to be on the front lines in the COVID-19 fight. These young men and women represent the best in us by selflessly providing this support and stepping up to help their community. The care they are providing is a testament to the education and training they receive today as they are working alongside their MD/DO colleagues providing the same level of care. We are proud and grateful for their actions.


 


Jeffrey M. Robbins, DPM, Director Podiatry Service VACO

04/01/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1


RE: Surviving COVID-19 Financially in the Office


From: William H FitzPatrick, DPM


 


The pandemic has prompted many of the medical pundits to predict the demise of solo practitioners because of their ongoing expenses and lack of income during the pandemic. One can save by laying off staff, but then there are those ongoing monthly expenses: rent and utilities, contracts for EHR, digital x-ray, diagnostic ultrasound, IT services and cyber security, answering service, vascular testing, PICA, APMA and state dues, specialty board dues, etc. 


 


Since there is a general acknowledgment that we are in this together and share the hardship, shouldn't we be approaching those vendors, suppliers, and associations and requesting a COVID-19 reduction in fees? Surely they realize like the beekeeper that unless she leaves the hive enough honey to get through the winter (pandemic) there will not be a harvest next year.


 


William H FitzPatrick, DPM, Albuquerque, NM

03/31/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B



From: John Chisholm, DPM


 



Thank you, Dr. Karulak, for again highlighting some of the reasons why our profession needs to continue to embrace the 4/4/3 model of medical education that we currently have. Although we limit our practice to foot and ankle medicine, our education and training produces a final product that, after 3 years of residency, is comparable to our physician colleagues. I believe his description of his residency rotations makes this clear.


 


When you look at all of the provider types that might be called upon to provide physician services during this crisis, the only degree type that has 3 years of comprehensive residency training, in all of the different medical disciplines, is the DPM.


 


It is my hope that this crisis will help to highlight the education and training of recently graduated podiatrists, and that Dr. Karulak will be allowed to use that education and training to save lives. And that eventually all 50 states will grant a full, unrestricted DPM license to anyone who has graduated from podiatric medical school and has passed the USMLE.


 


John Chisholm, DPM, Chula Vista, CA


03/31/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC)



From: Alan Sherman, DPM


 


Vincent Gramuglia, DPM’s brave and confident residents at DVA – New York Harbor Healthcare, Drs. Jacob Meclowitz, Danielle Du Bois, Ashley Kim, and Joseph Schmidl, stepping up to treat patients at the risk of getting infected with COVID-19 is the answer to Bryce Karulak, DPM’s comments on well trained podiatrists being better suited as backup care providers in a crisis like this than dentists, medical students and foreign medical graduates.


 


So many of our residents take their medical trainings as seriously as did Dr. Karulak, and do have the training in infectious disease mitigation, running ventilators, and generally, caring for very sick patients, that is needed to be very useful in dealing with the small percentage of COVID-19 patients that need to be hospitalized. I applaud Dr. Gramuglia’s residents and Dr. Karulak and am proud to know that they represent us so well.


 


Alan Sherman, DPM, Boca Raton, FL

03/30/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 2


RE: Podiatrists' Role in the Coronavirus Pandemic


From: Bryce Karulak, DPM


 


One colleague asked last week, do we have more of a role rather than keeping diabetics out of the hospitals? It begs the question for me of why our residency training is so in depth if we have no other role than to decrease the burden to the health system. Yes, it IS important to keep those with a laundry list of co-morbidities out of the hospital, especially when pedal manifestations of disease will be the reason they are admitted. But, don’t we have another place in the health system during crisis?


 


I spent 5 months of rotations on varying types of medicine. One of those months was with critical care where we managed patients on vents. I also did a month of anesthesia, again with vent management. I step foot into a hospital on a daily basis. We treat the sickest...


 


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

03/30/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC)


RE: Podiatric Residents and the COVID-19 Pandemic


From: Vincent Gramuglia, DPM


 


In today’s healthcare world, particularly in teaching hospitals, we are often too quick to criticize our colleagues’ shortcomings. At times, we are all guilty of this competitive mindset. If you have accepted the responsibility of another person’s health, you have to believe that you are the best at what you do. The real test, however, occurs when you are asked to put aside your personal needs and use your expertise to help others at your own peril. 


 


Four of our podiatry residents have chosen to provide aid at the risk of becoming a victim of the disease that they are attempting to help eradicate. Drs. Jacob Meclowitz, Danielle Du Bois, Ashley Kim, and Joseph Schmidl deserve our recognition for their courage and commitment to their profession. Podiatry is in good hands when doctors like this are around. Please join me in thanking them for their effort.


 


Vincent Gramuglia, DPM, Bronx, NY

03/25/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1



From: Patrick DeHeer, DPM, William Long, DPM


 


As always, APMA has been advocating for podiatrists. Our Legislative Advocacy team has been in constant communication with House and Senate offices over the past two weeks advocating for podiatrists as Congress works to pass relief legislation. Of particular concern are provisions to provide financial relief to providers who have been impacted by COVID-19; incentives to rehire providers laid off as a result of COVID-19; and the fallout of recommendations to cancel elective procedures and care (inadequate case volume, lost revenue, etc.).


 


Specifically, we are working to expand coverage stipulated as part of relief legislation to include up to 90% of practice losses due to closures and other loss of business as a result of COVID-19. If you have specific questions about APMA advocacy efforts around COVID-19, please contact ask@apma.org. You can find more information about relief at apma.org/covid19sba


 


Patrick DeHeer, DPM, William Long, DPM, Co-chairs, APMA Legislative Committee

03/24/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B



From: Ronald F. Iannacone, DPM


 


I like the clean pen/dirty pen idea. In my office, I have taken away all magazines and candy. I also put a sign on the table “if you read a pamphlet please keep it. Do not put it back.” Also, since my reception area is all open, I installed a 2.5ft high Plexiglas with a small 1 foot wide 3 inch high opening to pass info back and forth. Lastly, since hand sanitizer is in such short supply, I bought extra Menda pumps for patients to dispense alcohol with a tissue to wipe off hands. I have found patients are appreciative of these precautionary measures. 


 


Ronald F. Iannacone, DPM, Port Saint Lucie, FL

03/24/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A



From: Denis LeBlang, DPM


 



I practice in Rockland County, New York and so far we have had a small number of coronavirus cases but we are told it is coming and it can be a large percentage of people living here. I have closed my office to everyone except emergency patients and some post-operative patients from a few weeks ago. We have a mindset to treat and help our patients so most of us will stay open for these patients. I spoke with PICA and they told me if you close your office, you could suspend your coverage for as long as you are closed as long as you are not seeing patients.


 


We also feel that we have to make a living to pay our monthly bills. Our normal patterns have been...


 


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


03/23/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1D



From: Keith L. Gurnick, DPM,Vladimir Gertsik, DPM


 



In these difficult times, many patients still need to come in and get acute care and treatment. Patients with acute gout flares will make and keep their appointments, because they know how  much we can help to relieve their severe and acute pain. Don't make these patients go to an urgent care center or emergency room. Try to get them into your offices ASAP and they will be very appreciative for the help you render to them.


 


Keith L. Gurnick, DPM, Los Angeles, CA 



 



Many podiatrists may have decreased lung function caused by working with fungal nails. These individuals may be at high risk of dying from coronavirus. Coronavirus can cause severe lung damage even in healthy individuals. If you have respiratory problems or poor PFTs, perhaps it is wise to self-isolate. If your lung function is at 40% of normal now, do you think you will survive the virus? You can ask your pulmonologist or allergy doctor to check your PFTs. It is an easy test. It is also time to stop seeing routine patients. And I have a message for those still grinding nails: You are insane.  


 


Vladimir Gertsik, DPM, NY, NY


03/23/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1C



From: Andrew Levy, DPM


 



These are troubling and turbulent times for all of us. Looking at the pace of increasing warnings and increasing cases of the virus, taking in the advice and counsel of respected peers and advisers, the decision as to close, continue, or limit services seems to come down to when, not if. The state of Ohio has limited dental practices restricting all cosmetic, routine, and non-emergency care, allowing only pain-relieving care. It surprised me that I did not see the same pronouncement for podiatric practices. 


 


In Florida, we are seeing schools closed, restriction on hours for restaurants, and other closings. We have decided that we can wait for an inevitable order from the government or take proactive steps, like we would in the face of a Force 5+ hurricane coming at us. We have stopped all new patients, all routine care patients, and after we see our current round of follow-up patients from procedures, we are canceling all patients and care until at least the 2nd week of April. Then we will re-assess opening again. The rest of my response and advice to all of our colleagues - hunker down, it is going to be a rough ride personally, professionally, and financially.


 


Andrew Levy, DPM, Jupiter, FL 


03/23/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B



From:  Richard Simmons, DPM


 



When I submitted this letter for discussion on March 12th, one week ago, none of us had any idea that we would be facing what we are facing today. When I heard the request to isolate/quarantine for two weeks, I took it seriously. I have not seen patients this past week nor will I see them next week.


 


Mine is a house call practice and I can appreciate the difficulties my practice faces going from house to house, yet mine pale in comparison to what many of my office-colleagues are facing. From the New England Journal of Medicine, March 18, 2020, “If protecting patients is difficult, so is protecting healthcare workers, including nurses, respiratory therapists, and those tasked to clean the rooms between patients. When we spoke, Dr. D. was one of six physicians in his division to have a suspected COVID-19 infection.


 


Given testing lags...


 


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


03/23/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A



From: Lawrence Oloff, DPM


 


Everybody wants to help during this unprecedented crises. Everybody wants to fulfill their duties to their patients. But it is also important that this duty extends beyond foot care. When I read the posts about the coronavirus, I am getting the sense that many are not appreciating the seriousness of what is going on. Of course, maintaining social distance in the waiting rooms and doing an extra good job of cleaning is important, but the best thing you can do is keep patients out of your waiting rooms and your offices in this critically important time. The economics of what I am suggesting are dire, but the risks are worse.


 


Coronavirus is an untreatable condition and is spreading rapidly. It is affecting some areas more than others, but it will affect everybody eventually. There is no treatment. Antivirals are in early testing to curb the severity of the disease. Vaccinations are at least a year off. The numbers are going up exponentially. The ICUs...


 


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

03/20/2020    

RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC)


RE: Online CME and the COVID-19 Pandemic (Jeff Kass, DPM)


From: Alan Sherman, DPM


 


I wish to give kudos to Jeff Kass, DPM and all of the podiatrists who responded to his call for action to the State of New York Education Department, Office of Professionals, to remove the limitation imposed on podiatrists to earn their CME online. New York State limits podiatrists to earning only 50% of the 50 CECH required each 3-year period online. Their response was to temporarily remove the limitation for those podiatrists whose CME period renews March 1 - June 1, 2020. 


 


Well, that was the right thing to do considering the current circumstances of almost all podiatry CME conferences scheduled in the next few months being cancelled and so many podiatrists having to close our offices in the weeks ahead and having all this free time. Why not be able able to use that time for professional improvement and e getting your CME requirement fulfilled? But even without this particular crisis, in the larger context of us being in the 21st century, having to work longer hours to earn the same, being able to access all of our services like banks, insurance, utilities as well as all of the world’s knowledge from our phones, isn’t it about time that all states, including New York, allow podiatrists to earn all of their CME any way that they so choose?


 


Disclosure:  I co-own and run PRESENT Podiatry Online.


 


Alan Sherman, DPM, Boca Raton, FL
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