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07/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: The Part Can Never be Well Unless the Whole is Well


From: Leonard A. Levy, DPM, MPH


 


I truly believe that the following quote may have been written 2,400 years in preparation for podiatric physicians. In a play entitled Charimedes or Temperance written by Plato in 380 BCE, there is the following statement: “{A}s you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul. And this … is the reason why the cure of many diseases is unknown to the physicians of Hellas (i.e., Greece), because they disregard the whole, which ought to be studied also, for the part can never be well unless the whole is well.”


 


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

Other messages in this thread:


08/13/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Transition from DPM to MD and/or DO? Why Not Now?


From: Leonard A. Levy, DPM, MPH


 


Much of the ongoing discussions about DPMs becoming DPM/MD or DPM/DO are understandably based on politics within the podiatric medical profession. Giving up the DPM in exchange for acquiring the MD or DO to this day is a result of arguments by members of our profession on either side of such a transition. Certainly such a transition would not be without volatility. However, using the cliche that a rose by any other name is still a rose, recognizes that we already are physicians based on what we do. 


 


Our day-to-day responsibilities are virtually a true analogy with other speciaties in medicine such as, but not limited to ophthalmologists, otolaryngologists, and other organ-specific specialties. True, while they were in medical school, essentially the only difference between such specialists and podiatric physicians today is that the MD or DO curriculum includes clinical and didactic education and training in obstetrics and gynecology, psychiatry, and pediatrics.


 


This typically amounts to less than six months of time. Most of this could be reduced by providing some of what now is part of the pre-doctoral training of a DPM into graduate medical education (i.e., residency) so that these omissions could be removed. I do believe that someday this will happen (because of us or in spite of us).  Why not now?


 


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

08/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C



From:  Lawrence Oloff, DPM


 



This subject seems to have a cycle and I guess it's that time again. I think it is interesting that we want to be treated with respect and parity by the allopathic medical community, yet we don’t want to be held to those same standards. I am not sure what it is like in your communities, but in mine, orthopedic surgeons are required to be board certified to have surgical privileges. Hospitals realize that surgeons (podiatric and otherwise) are not going to be board certified when they complete their residencies. They grant a reasonable time period for recent graduates to obtain board certification status. Not that long ago, one of the orthopedists, at one of the hospitals I work at, was unable to pass the exam after several years. His surgical privileges were then revoked. Too strict? Maybe, but their rules.


 


The specifics of what privileges are granted is up to the hospital and is vetted by applicant surgeons submitting supporting documentation of their surgical experiences. I imagine we have all gone through much the same process, the same process as our allopathic colleagues. Surgical privileges in the allopathic world means... 


 


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


08/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Robert Scott Steinberg, DPM


 



I am not surprised by all the vitriol about boards. It has been a hallmark of our profession, and the inbred attitude of I'm better than you are; stuff I have witnessed for far too many years. More upsetting is the apparent lack of a basic understanding of hospital privileges credentialing. JCAHO is very strict. I can't imagine what they would do if they came into a hospital and while reviewing physicians' privileges, seeing "board certified", and the board not identified. Credentialing requires hospitals to verify with every board. 


 


The day after podiatrists finish their 3-year program, they can apply for privileges and get them. There is a time frame for completing board requirements, which a hospital can extend. If a podiatrist fails a board exam, what in reality actually changes the next day? Are they suddenly unqualified? Department chairs can and should observe new surgeons just getting on staff. 


 


And, what about the continued complaints about the boards? They fall on deaf ears. If a podiatrist who does not pass the boards the first time happens to be sued, can failing their boards be used against them?


 


Robert Scott Steinberg, DPM, Schaumburg, IL


08/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Steven Selby Blanken, DPM


 


In 1995, I became double-board certified by ABPS (Foot Surgery) and by ABPO (Podiatric Orthopedics). Since then, ABPS changed its name to ABFAS but did not merge with another board. However, ABPO merged with another board, making it ABPOPPM. When that occurred, there were some grandfathering that was granted (just like ABPS did with the MIS board years prior). However, after much confusion and dismay, ABPOPPM did not grandfather all of its ABPO members, but did to most, but not all. 


 


ABPOPPM's re-certification process was very different from the original ABPO's process, and after one re-certification process, I decided that I would not do it again 10 years later. In my area, as in many, ABFAS (ABPS) was the main certifying board that enabled me to get onto hospital staffs for full privileges, including most surgery allowed by the state. It also helped me stay on my insurance plans. I feel ABFAS is the only board that is recognized by APMA that can actually get one the certification necessary for many hospital staffs. I hear they are trying out a better re-certification route as of this time, for which I commend them for this. I have maintained and plan to retain my ABFAS certification. I do not have any regrets dropping ABPOPPM now known as ABPM.  It really didn't give me much added benefit.     


 


Steven Selby Blanken, DPM, Silver Spring, MD

08/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C



From: Vadim Goshko, DPM


 


I would be interested in hearing opinions on a view from different angle. Maybe the DDS model is more fitting for the world of private practice podiatry? What if those who claim “hospital surgical privileges” (as oral surgeons do), would legally drop their general practice and build practices fully dependent on referral from “non-hospital privileged” podiatrists and any other strictly surgical referrals.


 


“General practicing” podiatrists, by the way, still could perform surgical procedures (obviously, based on their training) in the quiet of their offices’ surgical suites (if they chose to have one). I’d like to see how those surgical podiatrists would like to compete for those cases (with MDs as well) and depend on referrals from their colleagues? The fact that there are few residencies that actually provide excellent training non-withstanding, let those graduates forgo their general podiatry practices. 


 


Vadim Goshko, DPM, Chicago, IL

08/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Kenneth L Hatch, DPM


 


Dr. Pressman hit the nail on the head. The public and hospitals should not be misled by podiatrists claiming board certification without stating which board they are referring to. The informed patient is very aware that board certification refers to a certain level of skill and training. The public deserves a truthful statement from ANY doctor. In Maryland, any statement referring to podiatric board certification must specify which board when advertising or printing stationery. When I see ABFAS when looking to refer out of my area, I am very confident that I am sending my patient to someone well trained. 


 


Kenneth L Hatch, DPM, Annapolis, MD

08/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Michael Loshigian, DPM


 


It is certainly interesting to see the charged and emotional responses to Dr. Lombardi's inquiry from several of our profession's most influential members. Before you allow yourselves to be "triggered" and attack Dr. Lombardi, I would encourage all of you who feel that the inquiry is controversial, unfair, or dividing our profession to take a moment and reread his post.


 


The first part of his inquiry simply states that the ABPM is spending money to help a member get hospital privileges and that Dr. Lombardi's hospitals allow ABPM certified people to have hospital privileges that include admitting patients and performing wound care, etc. The "etc." implies they are credentialed to do more than wound care. "But not surgical privileges" implies...


 


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

08/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C



From: Neil H Hecht, DPM


 


Just a quick comment about a recent post that quoted “allopaths protect their own” when there is discrimination from MD vs. DPM in granting hospital surgical privileges. Podiatrists ARE allopathic doctors. We do practice allopathic medicine, not homeopathy. We are trained exactly like traditional physicians albeit focused as a regional specialty.  


 


We may have a full-scope license in a limited portion of the body, but we all practice allopathy. If you don’t believe it, look up the definition of allopathy vs. homeopathy. Just my two cents after practicing allopathic podiatry for 42 years!


 


Neil H Hecht, DPM, Tarzana, CA

08/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Martin M. Pressman, DPM


 



I have been reading with great interest the back and forth of some of our finest thought leaders and I think they all have valid points. However, I think there are broader issues that need to be addressed. Here are some facts: 1. Hospitals are free to grant privileges based on individual training, experience, and competency with or without board certification. 2. CPME and JCRSB recognize only one SURGICAL board for podiatrists...ABFAS. 3. ABPM is not the surgical board for podiatry.


 


If you do not agree with these statements, then this discussion is over! If you are reading this, then you have accepted the above statements as true. The questions that get to the essence of this debate do not need to...


 


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


08/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Jeffrey Kass, DPM


 


Dr. Jacobs brings up some good points in his posting such as the fact that we unfortunately don’t have equivalent residency training among programs. In his defense of Dr. Lombardi’s query, he misses the main point. No one was stating that everyone should be granted privileges to “place an IM nail and fixator for patellar arthrodesis.” Dr. Lombardi clearly stated in his post “my hospitals have always allowed ABPM members to obtain admitting privileges... but not surgical privileges.” All doctors should only practice within their ability/skill set and seek help with areas that aren’t within their domain. 


 


I hope that anyone graduating from a three year program would be proficient with basic podiatric skills, i.e. hammertoes, bunionectomies, exostectomies, etc. To exclude these graduates from an OR due to not being board certified is ridiculous. We should be trying to elevate the profession by helping each other, not dividing the profession and excluding colleagues. Why not examine the root of the problem? 1) programs having unequal training 2) the low passing rate of the surgical boards. 


 


It amazes me why an anatomical location less than 12 inches has multiple boards to begin with. Finally, NYSPMA has spent hundreds of thousands of dollars, if not more, to try to advance scope of practice for all. It is disheartening to hear a member of the executive board doesn’t share this vision, particularly when members’ dues helped advance his scope. 


 


Jeffrey Kass, DPM, Forest Hills, NY

08/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C



From: Bryce Karulak, DPM


 


While I absolutely agree with Dr. Rogers’ point of view, this is simply not the case in Texas and I imagine in most states. I am dual board certified by both ABPM and ABFAS with both foot and RRA. Yet, I have been denied privileges even though I demonstrated training in residency and competence at other hospitals in the region that I DO have those privileges at. I have never had a malpractice suit to date. Yet my request was still denied. We (podiatry) are not considered the same and are held to a different standard than any other physician/specialty. Allopaths protect their own; we don’t protect our profession.  


 


Bryce Karulak, DPM, Fredericksburg, TX

08/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Bret M Ribotsky, DPM


 



It seems that the “common nerve” has been pressed once again: surgery vs. non-surgery, and today there is no 4% elixir that we can inject for a cure. It returns us to the primal podiatric question: Who are we? Seeking this answer has been what the past 35+ years has been all about. We have had expensive comprehensive projects, The Selden Report, Project 2000, and many, many more seeking the answer. This has been the question since my first day in podiatry school in 1984.


 


Back then, the top of the class became surgeons, and the rest just were left out. While Allen, Charlie, and the many other great contributors to our profession have pointed out that all training is important, it should be clear that most great leaders strived for certification in every boards they could. At a great cost in money and time, driven to be the best we could be, many of us became certified in...


 


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


08/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Bryan C. Markinson, DPM


 


I consider Drs. Charles Lombardi and Allen Jacobs my professional friends for many years. They have both treated me with tremendous respect which is mutual. I view both of them as esteemed members of our profession, and I am thankful for what they have done publicly on our behalf to elevate our profession. Their professional lives are largely involved with mentorship. Most importantly, I would have any member of my family treated by them without hesitation. They have both historically posted statements in this forum I have found patently outrageous, but sarcasm never offends me and occasional self-serving posts don’t usually offend me.


 


Dr. Lombardi, on August 3rd, asks what we may feel about his proclamation that ABPM certified (or really, non-surgical certified) podiatrists do not need and should not be granted surgical privileges in hospitals. Some may react with disdain, even disbelief at his directness. In view of current trends, certainly in about ten years, it may very well be that his vision will be...


 


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

08/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Richard M. Maleski, DPM, RPh


 


My question is not to the ABPM BOD, but to the graduating residents. Why not take the ABFAS certification test? If you want to have surgical privileges, then get board certified by our profession's surgery board! This really shouldn't be a question of who is qualified to do a particular procedure. There are many DPMs in my generation who, like me, have been involved in residency training, residency genesis, hospital privileging, and opening up hospitals to podiatrists for surgery.


 


Doing these things requires a thought process that needs to consider the overall well-being of the patients, the community, the individual podiatrists, the hospitals involved, even the hospital administration. It's just not the podiatrist or the podiatry profession. There is a responsibility to...


 


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

08/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Lee C. Rogers, DPM


Dr. Jacobs is incorrect. I did a surgical residency, namely a Podiatric Medicine and Surgery (PM&S) residency, I started in 2004 when all CPME-approved residencies were being standardized to be both medicine AND surgery.



However, I disagree that it is ABPM's certification (or ABFAS') that gives someone the authority to be granted surgical privileges. Legally, privileges must be based on education (DPM degree), training (residency), and experience (case logs). Training is key here. All DPM training is now standardized to a 3-year Podiatric Medicine and Surgery Residency (PMSR). So regardless if you are certified ABPM or ABFAS, your training in podiatric surgery entitles you to be qualified to do surgery. The last part is experience. If you have demonstrated the experience in doing surgical procedures, forefoot, rearfoot, melanoma, ulcers, whatever ... you should be granted the privilege to perform those procedures.


 


Lee C. Rogers, DPM, Algonquin, IL

08/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Allen Jacobs, DPM


There is very significant clinical experience heterogeneity within the “three-year” podiatric residencies. Both the surgical and medical education is variable from program to program. The completion of a three-year residency in no manner guarantees either surgical or medical expertise. Therefore, the board certification process in both medicine and surgery. Having been in active practice for greater than 40 years, and having participated in post-graduate education, residency training, reviewing malpractice claims, and my activity as an ABFAS examiner, I  suggest the following for consideration.



The DPM degree carries many trusted responsibilities to the public, the state, healthcare entities, and to fellow practitioners. The DPM degree confers a trust. This trust includes the determination of qualifications for board certification in medicine as well as surgery. A podiatrist struggling to perform...


 


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

08/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Gino Scartozzi, DPM


 


I read Dr. Lombardi's post and am somewhat troubled by a member of the ABPM Executive Board putting forth such a position questioning defending a podiatric physician from discriminatory practices allegedly for hospital privileges denied on the basis of which board is accepted by the hospital. The APMA has stated its position on this numerous times regarding hospital privileges and boards recognized for privileges.


 


Board certifications in podiatric orthopedics, podiatric surgery, wound care, and other podiatric subspecialtes should be encouraged. However, there is a far cry from a "board certified" physician and the demonstration of one's clinical abilities, even in the surgical arena, Dr. Lombardi. Do all podiatric surgical procedures require board certification? A board certified physician provides "better" care? Nope... 


 


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

08/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Dieter J. Fellner, DPM


 



Dr. Lombardi's question to the ABPM raises an interesting point. Such a concern would be founded, one might assume most assuredly, on a sound scientific basis. I will be extremely interested then to see the scientific evidence. 


 


Could it be true that three year residency-trained ABPM boarded surgical podiatrists fare so poorly in the surgical arena as to be denied surgical privileges by a hospital. All of the hard-gained surgical training in a three year residency will then amount to nothing.


 


Can a three year residency trained, and ABFAS boarded podiatrist outperform his brethren so magnificently that...


 


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


08/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Lee C. Rogers, DPM


 


Dr. Lombardi asks what ABPM’s position is regarding the criteria for granting surgical privileges. Quite simply, the ABPM believes that hospitals should follow State law and Medicare Conditions of Participation when evaluating a podiatrist for surgical privileges, and those privileges should be based on their education, training, and experience, not their board certification. This opinion mirrors that of the APMA, which can be found in the "Hospital Credentialing and Privileging Resource Guide", on apma.org. For further information, please see the ABPM’s Position Statement, "Hospital and Surgical Privileges for Doctors of Podiatric Medicine," published in JAPMA in 2019. 


 


That said, the ABPM is committed to providing the resources necessary to protect the credential from illegal discrimination. We encourage diplomates to contact the Board for assistance if they’ve experienced such discrimination in hospital or surgical privileges.


 


Lee C. Rogers, DPM for the ABPM BOD, Los Angeles, CA

08/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: In Support of Students' Request to Cancel CSPE


From: Janet Simon, DPM


 


The COVID-19 pandemic has certainly brought forth unprecedented challenges for all of healthcare, and our podiatric medical students have not been exempted. American Podiatric Medical Student Association (APMSA) President Israel Bowers has clearly voiced the concerns our students are dealing with pertaining to the APMLE Part II Clinical Skills Patient Encounter (CSPE) exam.


 


The request of APMSA to cancel the 2020 CSPE is reasonable during these unusual and stressful times. Our MD counterparts have done so. I encourage my peers to let the National Board of Podiatric Medical Examiners (NBPME) know our profession is fully supporting our students. NBPME Telephone: (814) 357-0487 E-Mail: NBPMEOfc@aol.com


 


Janet Simon, DPM, Albuquerque, NM

07/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Pete Harvey, DPM


 


Like Dr. Shea, I congratulate Dr. Mark Block on spotting a DPM omission in an important publication. It behooves all podiatrists to be continually vigilant on this front. A local case in point is the department responsible for licensing Texas DPMs, TDLR. TDLR has a recent requirement for Texas DPMs to take an online course in Human Trafficking. TDLR refers DPMs to a course offered by TRAIN. Yet, when trying to register with this group, the DPM is faced with an array of circuitous routes to register. In navigating that maze, one quickly discovers that the DPM is relegated to a non-physician role. This omission is noted in many fields of the registration. Hopefully, this will be corrected in the future.


 


Pete Harvey, DPM, Wichita Falls TX

07/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Tim Shea, DPM


 


Congratulations to Dr. Mark Block on his pick-up of the omission of DPM from a recent government publication. Through his efforts and APMA, we received a 2 for 1 result. Inclusion in the program and the clear delineation of DPMs as physicians with MDs and DOs. Congratulations - job well done. 


 


Tim Shea, DPM, Concord, CA

07/27/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: A Win for the Profession with the Assistance of APMA


From: Mark S Block, DPM


 


Several months ago, I received a communication from the Federal Government regarding “Guidance on the Essential Critical Infrastructure Workforce.” While reading through the numerous pages, I came across the following: “IDENTIFYING ESSENTIAL CRITICAL INFRASTRUCTURE WORKERS... Healthcare providers including, but not limited to, physicians; dentists; psychologists; mid-level practitioners; nurses; assistants and aides; infection control and quality assurance personnel; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists.”


 


Having noticed that DPM was not included, I reached out to APMA for assistance in rectifying this significant exclusion. I am pleased to announce that the APMA Health Policy and Legislative departments were successful in accomplishing and expediting a favorable result for the profession. This win continues to validate my belief that without APMA’s advocacy for the profession and our patients, we would be at a distinct disadvantage. Their skilled, professional staff and consultants have the appropriate infrastructure and experience to facilitate these types of positive results.


 


The new edited version contains the following correction that is a result of APMA’s initiative and efforts to correct this significant error: “Healthcare providers including, but not limited to, physicians (MD/DO/DPM); dentists; psychologists; midlevel practitioners; nurses; assistants and aides; infection control and quality assurance personnel; phlebotomists; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists.”


 


Mark S Block, DPM, Boca Raton, FL

07/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jay Seidel, DPM, Richard D Wolff, DPM


 


I use faxage.com. It's $7.95/month for 300 minutes incoming, which is usually enough for my 3 offices. I can also fax out using their web portal, which is pretty user-friendly. They also are happy to sign a BAA, which I believe is a requirement, while other fax companies would not agree to that for me.


 


Jay Seidel, DPM, Deerfield Beach, FL


 


Windows Fax and Scan comes standard with Windows operating systems. A USB fax modem runs $15 to $25. You plug in your existing fax line and there is no additional cost. You can fax anything that can be printed. You don't have to be a computer genius to use it. You can also store the fax numbers of all your contacts. There is no third party.


 


Richard D Wolff, DPM, Oregon, OH

07/21/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: COVID-19 and its Effect on Physician Demand


From: Leonard A. Levy, DPM, MPH


 


According to Bruce Japsen in Forbes (July 14, 2020), the ability of a U.S. physician to land a job was easy until a surge of U.S. cases of COVID-19 “flipped” the job market, reducing the demand for doctors during the pandemic. As hospitals curtailed elective procedures to make way for COVID-19 patients, doctor offices, clinics, and other health facilities closed across the country due to safety and shelter-at-home orders. Physicians lost their jobs or had their hours curtailed dramatically. 


 


Since March 31, “search engagements” on behalf of clients like hospitals that hire physicians, dropped more than 30%. A growing number of physicians are unemployed with a limited number of roles available. COVID-19 essentially flipped the physician job market in a matter of 60 days. However, primary care physicians as well as nurse practitioners and physician assistants remain in high demand.


 


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