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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
Other messages in this thread:
01/29/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: John Chisholm, DPM
I'm sure we all agree on one point: to quote the great Jon Hultman "podiatric physicians are either over-trained or under-licensed". We all agree that "parity" is a necessary but as yet unrealized goal for our specialty. What is challenging for us to agree on is the best strategy for achieving our goal. The California Podiatric Medical Association has been working for years to change our current, restricted license to an unrestricted, plenary license. This strategy would not require a degree change; it would require a different kind of license.
The next hurdle we have to clear is to have podiatric medical students take, and pass, the USMLE or other national licensing exams. I urge all of us to continue to support APMA and state organizations to clear important hurdles so that we can finally have a license that matches our education and training.
John Chisholm, DPM, Chula Vista, CA
01/29/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
From: Tilden H Sokoloff, MD, DPM
Leonard Levy DPM, MPH, is spot on. In spite of the “California leadership” working with the California Medical Association and California Orthopedic Association in gaining a plenary license, the issue is bigger than one state.
For our graduates and well trained podiatric physicians to achieve this status, we need a collective stewardship. The APMA has to make this a priority and pull out all the plugs. We have educators, who have the vision, have gone through the process, have ECFMG certification, and have passed the USMLE. Bryan Caldwell MD, DPM is Senior Associate Dean of Academic Affairs at KSUCPM. Daniela Capota MD DPM, practices internal medicine and pediatrics in Florida. I name these people because they are in proximity to schools of podiatric medicine. We have others who are licensed MD DPMs who have finished medical residency programs in the USA with a minimum of additional training in clinical areas.
As Leonard said,” if not now, when?” He knows the “how”. He was Dean, President of many podiatric medical institutions, and osteopathic medical schools. He understands process of accreditation, getting students through the entire process. He is well respected in the medical education community. He started an accredited DPM DO Program at Nova Osteopathic Medical School for podiatric residents. Let’s use our resources well and not reinvent this wheel. Medical education is in disarray, USMLE is redefining how to measure competency and, as of yesterday, the USMLE dropped the clinical skills test permanently. Too much talk and no action = 0. Nurse practitioners have gotten full scope practice licenses in 29 States. We can do this.
Tilden H Sokoloff, MD, DPM, Ketchum, ID
01/21/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Elliot Udell, DPM
In this case, both Drs. Levy and Jacobs are correct. Podiatrists are as well trained as any other medical professional in the early management of a severe allergic reaction to any injected medication. As a severe allergy sufferer, I've often asked the professionals who give me my allergy shots how many times they have encountered anaphylaxis. Most said never, but they have guidelines as referenced by Dr. Jacobs hanging in the office, "just in case."
In our office, as with most of my colleagues, we stock epi and injectible antihistamines, and pulmonary support devices and have the protocol hanging in the office. In over thirty years, I have never had to treat a single case of anaphylaxis. On the other hand, I have had to perform CPR three times and was successful two out of the three times and was assured by the ER docs that my only failure had nothing to do with my technique but rather an issue of arriving at the scene way too late.
Elliot Udell, DPM, Hicksville, NY
01/21/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
From: Leonard A. Levy, DPM, MPH
I do respect the comments of Allen Jacobs, DPM, but DPMs do need to be careful about what they say. Whether we administer vaccines or any of the many other drugs we may employ (and my understanding is that we are indeed allowed and hopefully capable of safely administering other drugs by mouth and parenterally), we also need to be able to be prepared for adverse reactions that patients may experience. If we are not, then it may be questioned by others as to why we are so permitted to administer such agents.
A large percent of COVID-19 vaccinations are given by pharmacists and many other healthcare workers who are not specialty trained physicians. Furthermore, we are experiencing what is perhaps the most serious public health emergency in the history of the world and almost a quarter of all COVID-19 deaths have occurred in the U.S. The capabilities of the podiatric physician should not be under-estimated.
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL
01/20/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Allen Jacobs, DPM
Dr. Levy suggests that podiatrists are adequately trained and equipped to administer the COVID-19 vaccination. He further suggests that the reluctance to permit the administration of such vaccinations is political, founded in a lack of understanding of the podiatric medical education.
Dr. Levy posits that a simple injection of epinephrine is all that is required for major adverse reaction to the vaccine; anaphylaxis is believed to occur in 1 per 100,000 doses. However, the occurrence of symptoms such as tachycardia, hypotension, cardiovascular collapse, laryngeal edema, nausea, vomiting requires more than epinephrine. Supportive equipment and care must be readily and immediately available.
I believe that he is wrong. A podiatrist is no more capable of screening for or the handling of emergencies than an orthopedic surgeon, urologist, dermatologist, or any office-based community healthcare provider. Clint Eastwood as Dirty Harry famously said, "a man needs to know his limitations." This is a matter of public safety, not a political issue. I suggest those who are considering administering the vaccination read this.
Allen Jacobs, DPM, St. Louis, MO
01/20/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
From: Elliot Udell DPM
Dr. Levy makes a good point that DPMs are well trained to give IM injections of a vaccine and if there is a manpower shortage, we as a profession could solve the problem. Let’s be honest and take this one step further. A monkey could be taught to give an IM injection. The injections that podiatrists give all day long require knowledge and training. Hence, if the powers that be at the various states get their acts together, we could help solve this very serious problem and really make a difference for our society.
Elliot Udell, DPM, Hicksville, NY
12/28/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Dieter J Fellner, DPM
I have to concur with Dr. Kass. It seems the Governor was, in making this provision, inadvertently provided with the training and qualification requirements of the British chiropodist as applicable in the mid-1960s. Will someone please provide the Governor the training requirements of a 21st Century podiatrist, USA. That should resolve the issue! Whatever next, perhaps the Governor would like to legislate that the podiatrist may treat the ingrowing toenail under supervision of the pedicurist.
Dieter J Fellner, DPM, Yuma, AZ
12/25/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Joseph Martin Quezada, DPM
Within days after the application of Pfizer-BioNTech-mRNA, 2.79% were unable to perform normal daily activities, unable to work, or required medical care from a doctor or healthcare professional. I recommend that doctors review the CDC link and make informed decisions. (cdc.gov/vaccines/acip/) In addition, in 2011, the Supreme Court declared that all vaccine designs are "unavoidably unsafe" and "unavoidably defective" due to "unavoidable adverse side-effects" presumptively caused by defective vaccine "design." The Court held that, even where vaccines are free of "manufacturing" and "labeling" defects, they are nevertheless presumed to come with a risk of "unavoidable adverse side effects" caused by defective "design."
The Court ruled that: (1) "design defects" must be the cause of any and all vaccine injuries and deaths; (2) All "design defects" are unavoidable, along with the resulting harm. In plain English, all vaccines are "unavoidably unsafe" precisely because they are "unavoidably defective." The FDA has never even spelled out in regulations the criteria it uses to decide whether a vaccine is safe and effective for its intended use." [Bruesewitz vs. Wyeth LLC, (2011) 562 U.S. 223]. I would never get a vaccine shot nor give one! I trust in nature (God) and let nature take its course!
Joseph Martin Quezada, DPM, Laredo, TX
12/24/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Elliot Udell, DPM
The individual states have to decide what doctors should get the COVID-19 vaccine first. A lot will depend upon the supply of the vaccine. It should not strike us as being unusual that an ophthalmologist was "first on line." Eyecare professionals have a strong disadvantage in this pandemic. Their faces are right up against the faces of their patients which renders them very likely to be infected. The same would apply to dentists, ENT doctors, and GI specialists who do upper endoscopies. Even though podiatrists tend to work close to six feet from patients' noses, make no mistake, we are all at risk from the moment we turn the key in our doors and we should not wait a day to be vaccinated when the offer is given to us.
Elliot Udell, DPM, Hicksville, NY
12/24/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
From: Wenjay Sung, DPM, Pete Harvey, DPM
I received my vaccine on Friday and actually was given the opportunity to sign up on the first day for vaccination with the “high risk” medical personnel like ICU, ER, etc. I’m not a “staff” podiatrist at my hospital but I do take ER call and I’m frequently consulted for inpatient services. I don’t believe podiatrists were excluded or I was given preference at my hospital because I’m way too young to be senior in anything.
Wenjay Sung, DPM, Arcadia, CA
If you're on active staff of a hospital, they will inform you of your tier turn after injections have been provided to ER workers and other staff who work closely with COVID patients. Be sure that you are on the hospital email list by checking with the medical staff office. Your hospital’s Covid injection supply will also play a role in the timing. Otherwise, I would check closely with your own family physician.
Pete Harvey, DPM, Wichita Falls, TX
06/22/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Lee Rogers, DPM
The American Academy of Family Practice has a useful preparedness checklist for physician offices during the COVID-19 pandemic.
Lee Rogers, DPM, Las Vegas, NV
06/22/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
From: Larry Schuster, DPM
My waiting room used to be a major social gathering place as patients would enjoy seeing friends and relatives every few months before or after their visits. I have seen offices where they placed tape over every other chair to allow for some social distancing. Of course, chairs would have to be cleaned before and after each seating as we do in our treatment rooms.
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Note: Magazines have since been removed |
My simple solution is pictured above, anti-social, simple but effective. We take each patient directly to a treatment room. Fortunately, we have 5. Scheduling is very carefully done and no patient actually comes in contact with another. Everyone is masked and universal precautions have always been followed.
Larry Schuster, DPM, Parsippany, NJ
06/10/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
From Ron Werter, DPM
It’s great that you continued to pay your employees for not coming to work. I did that for a few weeks, but then we both realized that they would make more money by going on enhanced unemployment. Do your employees realize that they are losing money by your continuing to pay them?
The upside is that you can have them come back to work immediately when you re-open, whereas I have to negotiate with my employees because the enhanced unemployment ends on July 31 (Unless, of course, reduced hours will still allow them to collect the extra money).
Ron Werter, DPM, NY, NY
06/08/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
RE: Loyalty and the Coronavirus Pandemic
From: Dieter J Fellner, DPM
In these troubled days, so many podiatry (and other) businesses let go of their staff, sometimes with indecent haste. I want to share the business and life philosophy of one of NYCs' young entrepreneurs, Louis Rossman. He is in the electronic repair business. And here is what he has to say about it:
"People said I'm a good employer - I am telling you I am not. I paid all of my staff who chose to stay home, even before I got PPP stuff. If you were one of those full time people, and you chose to stay home during that time period, I paid it in full. That was BEFORE the PPP loan went through; before I even knew there was a PPP thing. That is not because I am a kind, benevolent, and good-hearted man. That is because...
Editor's note: Dr. Fellner's extended-length letter can be read here. Louis Rossman's complete YouTube video can be viewed here. The referenced text starts at about 14 minutes. Note: This video contains some course language.
05/18/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
RE: Should DPMs Charge a PPE Fee?
From: Bret Ribotsky, DPM
As I watch my colleagues begin to open in post-COVID times, I wonder if anyone is charging a PPE fee to patients? I see that the dental profession is charging a “fee” for all the extra costs needed to provide care. I have read statements on the American Dental Association (ADA) webpage that show a collective action to charge for these extra costs.
I see that this topic is not (yet) covered on the APMA COVID webpage. While the profits (margins) have continued to decrease to the podiatric physician, I worry how this added cost (if not passed through) can be absorbed at the current reimbursement rates. I recognize that the logistics (insurance contracts, etc.) need to be worked through, but we all know that in a crisis, there is always an opportunity.
Bret Ribotsky, DPM, Boca Raton, FL
05/06/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
RE: HHS Stimulus Payments
From: Paul Kesselman, DPM
For those of us who have been fortunate enough to receive the first round of HHS Stimulus payments, be aware that a second round was released early last week. However, you must actively attest to the first round first. Without attestation, you will not be eligible for these grants. If you don't attest but do not arrange for returning the money you did receive within 30 days, you will have been considered as attesting.
While most of this may already be considered old news, my prediction has come true of government auditors being hot on the trail to ensure that you have spent this "grant" money appropriately. Recently, the Trump administration announced that in fact there will be an accounting of this money by appropriate federal agencies, including but not limited to OIG. The message here is to be sure the grant money is not transferred to a personal account and that the money you received stays in a business account and is used to pay business expenses only.
Paul Kesselman, DPM, Woodside, NY
05/05/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
RE: COVID-19 and Social Office Spacing
From: Keith L. Gurnick, DPM
We will all have to come up with our own individual ideas and solutions to address the multitude of complex new "social spacing" issues that will confront us moving forward. Each practice will need to figure out how to best facilitate the flow of staff, suppliers, patients, and deliveries in and out of their offices to maintain a safe and healthy work environment.
My solo practice is located on the 7th floor in an 18-story medical building directly next door to a hospital, all on the same property. We have put up signs and taped off waiting room chairs to allow for social spacing. In addition, we have added additional folding chairs in the hallway just outside our waiting room door, thus expanding my reception room into the hallway just a bit. In addition, we are now keeping the reception room door open at all times so patients will not need to touch the door knob to enter or exit the office.
PM News would be a great forum to hear what others are doing, will be doing, or are considering to address the issue of social spacing in our medical practices.
Keith L. Gurnick, DPM, Los Angeles, CA
05/04/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
From: Vince Marino, DPM
Dr. Neuhoff should consider herself very lucky. I wonder if she banks with a small bank that is also an SBA lender. I bank with Bank of America and it has been a true nightmare - multiple changes in the applications, absolutely no way to contact them with questions or status updates. Total silence. As a result, I have applied for the second round with 7 different lenders trying to hedge my bets. The big banks (B of A, Wells Fargo, JP Morgan/Chase, etc.) catered to their big clients first to reap in the billions in fees they collected (6 billion from the first round are conservative estimates) - that coupled with the glitch in the program allowing entities such as Shake Shack, Ruth Chris Steak House, nd McDonalds to name a few to use each franchise as a different entity with less than 500 employees. Congratulations to Dr. Neuhoff. I wish the rest of us luck.
Vince Marino, DPM, Novato, CA
04/29/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
RE: New Study of Famotidine for COVID-19 and Possible Relationship to Verruca Treatment
From: Steve E. Abraham, DPM
A few years ago, I wrote an article for Podiatry Management about cimetidine for recalcitrant verrucae. I had mixed responses. 50% of the patients who used cimetidine for warts had complete resolution in 4-6 weeks of oral treatment. Alas, about 50% had no response and needed more aggressive treatments. I used this for children to avoid pain.
I had a relative who used high doses of oral cimetidine for herpes infection, and after 6 weeks, it cleared up. A serological test was positive at the time the skin lesion was excised by a dermatologist, and 6-8 weeks later, the serology test was negative. Were all of these "anecdotal" conclusions merely coincidence? Perhaps.
Yet, I read this morning about a study for the treatment of severe illness due to COVID-19 using high doses of intravenous famotidine, the active ingredient in Pepcid, a drug in the same family as cimetidine. It was hypothesized that cimetidine affected H2 receptors and activated an immune response to the virus. This study on famotidine will be with 1,200 subjects-patients. This may add credibility to the use of cimetidine for warts.
Steve E. Abraham, DPM, NY, NY
04/28/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
From: Vince Marino, DPM
From all I have heard, most landlords have been very understanding- especially if you usually pay your rent on time and are a problem-free tenant. I have three office locations and the landlords in all three have been understanding. One landlord is Sutter Health, and we are in their medical office building adjacent to the hospital. They have allowed us to defer the rent (except for still being required to pay the operating expenses they have built into the rent, so about 50% reduction). We are dividing up the rent we are deferring and spreading it out over the life of the remaining lease.
The other office is pure retail space, and that landlord is giving us 3 months of not paying rent but they are adding 3 months onto the end of our lease, so in essence – 3 months free.
The third office is a sublease from a group of spine surgeons, and since they got a 50% reduction from their landlord, they are giving us also a 50% reduction in the rent.
Vince Marino, DPM, Novato, CA
04/24/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
RE: Employees in the COVID-19 Pandemic (Jill Hagen, DPM)
From: Brian Kiel, DPM, Jeffrey Worman, DPM
Let me get this straight. The doctor wants her office manager to work for free 20 hours a week so the doctor can have an income and then calls the employee lazy for getting $300 more in unemployment than her salary. I can’t imagine how little her salary was but I say - why would she not?
Brian Kiel, DPM, Memphis, TN
It is my understanding that the amounts currently being paid for unemployment are being bolstered to help people during this crisis. It is also my understanding that normal unemployment wages are far less than the standard 40 hour work week pay. More importantly, in my mind, is that Dr. Hagen's logic that any employee would simply do a "mitzvah" for 20 hours a week with the promise of "this being remembered when this whole disaster is over." You can't read possibly read that sentence and think that makes sense. I have VERY loyal employees who are dedicated to me and my practice, and they are compensated for such. To expect them to do it for 20 hours/week for free is completely laughable.
Jeffrey Worman, DPM, Largo, FL
04/23/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
RE: Employees in the COVID-19 Pandemic
From: Jill Hagen, DPM
After much consideration, I closed my office on 3/13/20 due to COVID-19. One employee was 5 months pregnant, so I had to put her on unemployment. Then, I decided to put all my employees on unemployment. I asked my office manager if she could help me out 20 hours per week to keep me up-to-date with accounts receivables. I told her she would be doing a “mitzvah” (good deed) and it would be remembered when this whole disaster is over.
Then she got accepted for unemployment. Her unemployment benefit came out to be $300 more per week than if she was working 40 hours per week. She proceeded to tell me that if I need her to help, I must pay her for the extra hours she puts in. I told her no thanks. This government is crazy. It’s nice that people are getting compensated, but why is our government paying people for sitting on their asses at home more than if they went to work? Does this make sense? There’s no incentive to work, so these lazy employees won’t even help in a disaster situation. What happened to the good people in this world?
Jill Hagen, DPM, Englewood, NJ
04/21/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
RE: Appreciation for Those Who Stepped Up in the Pandemic
From: William H FitzPatrick, DPM
I would like to add to the appreciation we’re giving to all the frontline workers during the pandemic. In addition, I’d like to add a big "thank you" to APMA and PICA for their financial concessions to members and professionals. Also, a big thank you to the IT, digital x-ray, EHR, advertising, vascular, and others of our vendors for giving us contract fee reductions. They won’t be forgotten when normalcy returns and we continue our business associations.
William H FitzPatrick, DPM, Albuquerque, NM
04/21/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1A
RE: Podiatric Residents and the COVID-19 Pandemic
From: Amira Mantoura, DPM, Mike Piccarelli, DPM
Residents currently serving in hospitals with high volume COVID-19 patients will be some of the best trained ever. There is no substitution for the experience gained by playing in a live game. Thank you for stepping up. We are all proud of you.
Amira Mantoura, DPM, Stamford, CT
I applaud all of the residents, attendings, and nurses who have answered the call for help with the COVID-19 outbreak at their respective hospitals.
As the program director for Richmond University Medical Center Staten Island, NY, I particularly would like to thank my residents (one of whom was infected and has thank-God recovered and is back at work) for stepping up when called on. They are working 12-hour shifts, 6 days per week in the epicenter of the outbreak in NYC. Even with the overwhelming nature of the work, they have shown remarkable resolve in all that they have done.
Mike Piccarelli, DPM, Staten Island, NY
04/20/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1
MN Podiatrist Concerned about Lack of PPE in Long-Term Facilities
Long-term care facilities remain a topic of concern amid the coronavirus pandemic. Podiatrist Jengyu Lai, DPM, Chief Manager of the Rochester Clinic, travels to those types of facilities in the Rochester area. Some are not allowing visitors at all, even specialists, while others only allow specialists like him in. According to Dr. Lai, he has to always check to his temperature and answer questions when entering each facility while also putting on new personal protective equipment (PPE) and that he started wearing masks before they were mandatory at the facilities. He says that since residents don't have many visitors (if any), residents are always excited to see him.
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Dr. Jengyu Lai |
Lai has concerns about the level of PPE supply at these facilities saying, "My concern is most of them do not have enough protection gear, especially like masks. Even though they want to go out, most of them have to use the surgical masks but they have to re-use them. Some do have the homemade masks but they only have one and you can't really have just one. You really need to wash them, clean them, and to alternate."
Source: Zach Fuller, KTTC [4/15/20]
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