|
|
|
|
|
Search
07/15/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
RE: Online Learning vs. Live Lectures?
From: Bret Ribotsky, DPM
I’m sure I’m not alone in missing the way it was just a few months ago. Attending seminars, asking questions, and discussing issues at the hotel bar into the late-hours of the evening, that’s how I have learned. I’ve had the privilege to give over 750 lectures in 48 states and ten counties, and there is a feeling that has not been reproduced via on-line learning. I remember in the early 2000s sitting in a hotel lounge with Warren Joseph and the late Harry Goldsmith (my mentors) as we discussed how our styles of lecturing, while totally different, were all very effective.
What was the common thread? I believe that night, after a few drinks each, we all agreed on one common denominator, passion. Warren, Harry, and I were collectivity masters in holding an audience’s attention with our passion. Today’s online learning, to me, is missing the passion. Am I alone?
Bret Ribotsky, DPM, Boca Raton, FL
Other messages in this thread:
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jack Ressler, DPM
Why pay someone thousands of dollars to evaluate your own practice when all they are going to do is look over your numbers without even making an in-person evaluation of your office? They will offer to come out and evaluate your practice but at an even higher price. You can save money up front and sign a contract with other companies that will charge you a percentage of your sale price but you are at their mercy and cannot control the extent at which they advertise your practice. Signing with one of these companies gives them complete control of the sale of your practice even if you find your own buyer. I doubt they will give you exclusions.
Who better to value your practice than yourself? It is you who know your patients, staff, physical office set-up, demographics, and numbers better than anyone. The valuation of your practice comes down to one simple thing and that is the number a potential buyer is willing to pay. When I sold my main practice in 2016, I advertised it in the classified section of this forum. I did all of the work myself and paid a very reasonable amount for advertising and...
Editor's note: Dr. Ressler's extended-length can be read here.
05/10/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Richard M. Maleski, DPM, RPh
The recent thread in this forum on the future of podiatry has been extremely interesting and thought-provoking, with the most recent emphasis on the pros and cons of direct pay versus the more typical insurance dominated practice model. Let's not lose our historical perspective on this. Back in the 1960s, with the advent of Medicare, everything in healthcare changed. Prior to that, virtually all practices were direct pay, and the only insurance coverage was Major Medical, sometimes referred to simply as "hospitalization." When Medicare came around, our profession clamored to be included.
There are colorful stories of the behind closed doors antics that went on inside politicians' offices to assure that podiatric services would be covered. Since then, any time there has been a change, such as the emergence of managed care, we, along with every other medical group have done everything possible to keep ourselves included. And by being included in this payment model, we have been able to expand our status within...
Editor's note: Dr. Maleski's extended-letter can be read here.
05/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Kathleen Neuhoff, DPM
It is unfortunate that local providers turfed their patients to Dr. Tomczak. However, in our area, this kind of turfing is rampant among those who accept insurance. Most of our local Latino population does not have insurance and many providers will not see them at all.
Ironically, when I accepted insurance, I was taken to task by the administration of our local hospital because I gave a significant discount to all religious leaders (rabbis, priests, ministers, nuns, etc.). I was advised that I was in violation of the contracts with my insurance carriers and had to “cease and desist”. Now that I have no contacts with insurance companies, I have restored these discounts. I also see large numbers of patients who have no insurance and am able to provide care for them at a cost they can afford.
Some of these patients are very sad. For example, Wednesday I saw a gentleman who had had an ingrown nail for months. He had been unable to find anyone to treat him until the local” free” clinic sent him to me. He is an uncontrolled diabetic and had osteomyelitis of the entire distal and part of the proximal phalanx. I had him admitted to the hospital which will end up eating the cost, and I will probably need to amputate at least his hallux. We have failed this patient at a huge cost to him and to our healthcare system. I do not think this is an issue of self-pay vs. insurance providers. It is a loss of the patient care mentality which should guide all of us.
Kathleen Neuhoff, DPM, South Bend, IN
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Richard Rettig, DPM, Kim Antol
Quicken is a great product, and the most expensive version is $5.50 per month first year, then about $120 per year. Since you are outsourcing payroll (good idea), you never needed Quickbooks in the first place. Unfortunately, you cannot convert your Quickbook files to Quicken.
Richard Rettig, DPM, Philadelphia, PA
If all you need is a simple program to print checks....Quicken should do the trick for under $100. Not subscribing to online versions and options will save you from annual fees.
Kim Antol, President, Sigma Digital X-Ray
03/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ivar E. Roth, DPM, MPH
As I have mentioned before, I agonized for quite a while if I should charge a credit card fee. I have been doing so for the last 6 months with very little opposition.
For the few patients who complain, I usually just waive the fee to make them happy. In the end, I am saving tens of thousands of dollars per year which is a nice bonus.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
03/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Michael Uro, DPM
I just read Dr. Rod Tomczak’s response to “A Short History of Podiatric Discontent and Frustration”. I whole-heartedly agree with all he had to say. I have enjoyed practicing podiatry for 45 years. I was fortunate enough to have enjoyed the era before managed care...a time when we were paid 2/3s more for surgery than we are today. The reimbursements for surgery today are an insult to the training, experience, and risks that podiatric surgeons take every time they walk into an operating room.
When I came to Sacramento, I was welcomed by the podiatric, MD, and DO communities. I am grateful to those mentors such as Mitch Mosher, DPM, Larry Gerelli, DPM, Randy Sarte, DPM, and...
Editor's note: Dr. Uro's extended-length letter can be read here.
11/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Howard Bonenberger, DPM
I worked with Mike Crosby for evaluation, pricing, and negotiation of the terms of the sale of my solo practice in 2017. I found him to be a great resource. At a minimum, a 5-year look back at financials should be performed. I would avoid the low-priced consultants. You could leave a lot of money on the table.
There is much more to it than you can imagine. Find a highly regarded medical practice business attorney (not malpractice). Your CPA should also be involved if they are qualified in this arena and may be able to recommend an attorney to interview.
Howard Bonenberger, DPM (retired), Hollis, NH
11/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: John Throckmorton, DPM
You are the best one to know the potential valuation of your practice. You talk to your accountant and review at least the last 10 years of gross and net income, also any properties and equipment at today’s market value. If you have multiple offices don't leave out those secondary offices and their equipment. Do you have privileges at local hospitals, and are they open to a new doctor joining the staff? The gross income may be less now but also you may be working fewer hours due to your success and/or your age now. Younger DPMs, just starting out, usually work more hours than older established DPMs.
Ask your accountant and other docs at the hospital who they recommend. YOU and your accountant are the most knowledgeable to set the price. Don't pay a fee you may not need to! Most likely, the purchaser and/or company of DPMs (there are large groups of doctors and/or hospital conglomerates) will also have their experts do an evaluation of it. Good luck in today’s medical market.
John Throckmorton, DPM, Moorseville, NC
10/11/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Keith L. Gurnick, DPM
With all due respect to Dr. Allen Jacobs, podiatrists are often the first to diagnose acute gout, and we are often the doctors who treat acute flare-ups and chronic gout as well. I have come in to my office many times after regular office hours and on a Saturday or a Sunday for a gout emergency, and it is one of the most helpful and thankful things we can do when a patient is having an acute gout attack or flare up to help reduce or alleviate their severe acute pain disability and suffering.
Yes, it is true that we as podiatrists also make appropriate referrals to other specialists for systemic long-term management. However, we are often the first and best educators to our patients about the causes of gout, the short-term and the long-term affects as well, including localized effects in the foot and ankle and the long-term effects of poorly or uncontrolled...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
08/09/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Paul Kesselman, DPM
Of course, I acknowledge and agree with Dr. Jacobs regarding the significant limits of the LOPS exam. From my initial response to his letter, I had stated that the LOPS program is a flop simply because it was ineffectual because most diabetic patients would not qualify and the reimbursement is pitiful. What it includes is I also agreed that an E/M code was far more appropriate. The description I am advocating is to use an appropriate E/M. After all, is this exam not an evaluation and management examination?
As I discussed and Dr. Jacobs and the IWGDF have provided, a clear message that all patients with diabetes should be seen by a healthcare professional based on a tiered structure. It is inconceivable that third-party payers and MCR don't see the effectiveness in this message given the significant amount of money paid out for treatments related to diabetic foot pathologies, which eclipse those of many...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/10/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Steven Finer, DPM
I spent a day observing a chiropodist in Bermuda and a podologist in Spain. They both had the similar type of technical training. Their palliative skills were excellent and this is what they did. They had vague knowledge of pharmacology and overall anatomy. They viewed the body as a big foot.
The podologist was very excited to write a prescription for Neosporin. He also told me his dream was to go to New York to learn surgery. Naturally, they have no hospital affiliation. How can anyone equate a DPM with foreign technicians taught for a few years post-high school?
Steven Finer, DPM, Philadelphia, PA
07/04/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Lloyd Smith, DPM
The note from Dr. Saxena is exactly on target. From what has been written, there is no interest in compromise. That’s certainly unfortunate.
As I have previously stated, APMA or other interested parties should continue to attempt to provide a neutral environment for discussion and possible compromise.
Lloyd Smith, DPM, Newton, MA
06/30/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Michael M. Rosenblatt, DPM
Over the years, I have observed Dr. Robert Kornfeld describe that he jettisoned himself free of insurance coverage and made a success out of it. He practices in New York. Apparently, it works for him. I know of MDs and DOs who established themselves in a so-called holistic practice. I just never could understand how a highly specialized practice, say separate from gastroenterology or cancer care, could encompass a holistic medical treatment style. He does not mention if he practices any foot surgery and how any patients would be willing to self-pay for that.
Perhaps some of them obtained partial reimbursement from their insurance. But most insurance panels have strict rules about how doctors must exist in their framework. They might require separate exclusion contracts in order to avoid...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
06/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1b
From: Steven Finer, DPM, Bret Ribotsky, DPM
I sold my office in 2018. I then continued to see patients 9 hours a week at nursing homes and a few house calls. Then Covid hit and I quickly pulled the plug. I contacted the PA board and went Active Retired. Naturally, you still pay the licensing fee. You can still treat family members and prescribe. I also cancelled my malpractice insurance which had a tail. It took about 2 years for some of the insurance companies to stop sending info. This year, I shredded a number of retained records, keeping the required years. You must stay busy at whatever level you can. Family and health are the priorities.
Steven Finer, DPM, Philadelphia, PA
“Suum cuique” - To each his own. As I live in South Florida, home to many retired physicians, many of whom were my patients for many years, I’ve asked this question often. Almost all specialties keep their licenses active. Personally, it has been 8 years since the Coast Guard accident that placed me on permanent disability, I’ve given up my board certifications (even before they expired) and my DEA license. I’m keeping my Florida license (taking CME, etc.). Who knows the future? And if you do, please share your Powerball numbers.
Bret Ribotsky, DPM, Fort Lauderdale, FL
05/31/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
My experience with daily pot users has been just the opposite. This is an educational pearl for young podiatrists. If you have a patient in their forties or fifties with type 2 diabetes and neuropathy that has good skin texture, normal hair distribution, palpable pulses, and no history of chemo treatment, then this is diagnostic of a daily pot user. You don't even have to ask them, you can tell them.
Daily pot use causes neuropathy, impotence, and diabetes. If they keep using it, they most likely will die from kidney failure in their sixties. This has been my extensive experience with pot users. If you have a patient who has complete neuropathy, good skin, good pulses, and no chemo and they deny using pot, they are lying.
Gary Smith, DPM, Bradford, PA
04/24/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Michael M. Rosenblatt, DPM
Bilal Shamsi, DPM recently published a letter to PM News decrying the alleged "excessive number of podiatrists" graduating DPM schools. Medscape recently published a warning of the high number of physician retirements coming on board recently, which is expected to get much worse.
Of course, those described are MDs. Even in my community, I do not see a high number of podiatrists treating our expanding elderly population here in NV. I do see dentists on almost every block. There is nothing approaching...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
04/11/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Neil Barney, DPM
The best advice I can give is to lose the phenol and switch to sodium hydroxide.
The nail wound heals faster, with less drainage and almost no pain, and in my opinion, with less damage to surrounding tissue. I haven't used phenol since I left podiatry school in 1979.
Neil Barney, DPM, Brewster, MA
03/30/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Alan Sherman, DPM
Isn’t it remarkable how we can depend on our leaders year after year to cut through the noise and have us see an issue in a new way? Thank you Jon Hultman, DPM, for making that important point – We do have standardized residency programs in podiatric medicine and surgery now and at least for graduates of those programs, there should be one certifying board that certifies them as podiatric physician and surgeons.
If ABPM and ABFAS can’t be compelled by all the voices in our profession calling for a merging of their boards – maybe we should form a new board that covers podiatric medicine and surgery and represents ALL graduates of these standardized 3 year programs. It would and should include CAQs for those with advanced fellowship training and/or the ability to demonstrate competence in subspecialties. The existing boards would continue to represent those trained before the 3 year residency curriculum came to be.
Alan Sherman, DPM, Boca Raton, FL
03/29/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Noel Barnett, DPM
I agree with Dr. Perez that the problem is access. I believe that every DPM should be given the opportunity to sit for the boards. I think that it's a travesty that someone graduates from podiatry school with thousands of dollars in student loans and is denied the opportunity to make a living in order to pay back such a large student debt. The ABPM considers anyone who did a RPR & PSR residency to be ineligible for their boards, but you are eligible if you did a POR & RPR or POR & PSR residency. I always wondered how they came up with such a decision.
The ABMSP and other boards have been a lifesaver for many podiatrists who want to practice their profession but who are being denied to do so, because they are not certified by ABPM or ABFAS. You do not need to lower the standards for board certification but everyone should be given the opportunity to take the exam if they wish to do so. Podiatrists are leaving the profession and the enrollments for the schools are down. We are driving people away from the profession.
Noel Barnett, DPM, Stafford, VA
03/28/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Name Withheld
For years, I have sat silent reading the debate of my colleagues over board certification. It is amazing that a profession as limited as podiatry, with limitation on license and scope of practice, lack of job availability, competition from PAs, NPs, orthopods, we find more ways to hinder our profession to get ahead. Board certification is yet another self-imposed limitation placed by us on our members.
I unfortunately did not have the chance to become board certified. I did a RPR-PSR-12 residency when there was fierce competition for residency slots and there were no structures in place for a 3-year residency. By being a RPR resident, I am automatically disqualified by APBM. The CPME, the body that came up with RPRs, PORs, PPMRs, PSRs, for some reason decided that RPR was not good enough to qualify for ABPM. There is absolutely no rhyme...
Editor's note: Name Withheld's extended-length letter can be read here.
03/27/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Rod Tomczak, DPM, MD, EdD
Unfortunately, Dr. Roth is correct when he states that not every podiatrist can become board certified in foot and ankle surgery. I have refrained from making that statement, but I think it's true, and podiatry is not the only specialty to experience exclusion.
I was having a basal cell carcinoma removed a couple of weeks ago. During the procedure, I asked the dermatologist if he did much Mohs surgery. He told me he didn't do any. I asked him why and he said, "When I came to Ohio State, I hadn't done enough cases as a resident, and they didn't give me privileges to do them." He did not do a Mohs surgery fellowship. In 1991 there were only 37 Mohs surgery fellowships in the USA. Not every board certified dermatologist is viewed as qualified to perform Mohs surgery in an academic institution.
Rod Tomczak, DPM, MD, EdD, Columbus, OGH
03/23/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Walter Perez, DPM
Dr. Tomczak, your comment is well taken and yes, I do believe that our certifying board needs to be strong to have credibility in the medical world and with insurance companies. However, I have a problem with your final comment: "We do not want to be accused again of having weak boards and we don't want to return to the days of lawsuits and intra-professional animosity." I do not believe that issue is how strong or weak our boards are and, of course, we need strong boards, but the real issue is accessibility. Many podiatrists cannot sit for the boards because they do not have certain credentials.
I believe that the mere fact of having a DPM degree is enough to qualify for any of the boards and certainly, a single certifying board and subspecialties under it makes perfect sense to me. And we certainly do not want lawsuits or animosity and this is the reason why we need to come together and come up with sound solutions. The bottom line is, every podiatrist should have a path to board certification. It’s a win-win for our profession and our patients.
Walter Perez, DPM, Brooklyn, NY
02/08/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Scott Steinberg, DPM
Let me respond to Dr. Amarantos, and let you decide if it's worth it to continue to be a member of Guild 45 of Lower Extremity Surgeons, OPEIU, AFL-CIO. We complain our profession is not respected by other specialists, hospitals, or insurance companies. We do get respect from OPEIU-AFL/CIO. They even lobby for our profession. Here are some of the benefits
HEALTHCARE BENEFITS:
"As you know, we, through an agreement between the OPEIU and the United Steel Workers Health and Welfare Fund, have offered members and their families fully insured health policies written through Highmark Blue Cross Blue Shield. These policies are “rich” in...
Editor's note: Dr. Steinberg's extended-length letter can be read here.
01/20/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: William P Scherer, DPM, MS
I inputed to ChatGPT "Question - is podiatry a rewarding career?"
Response: "Podiatry can be a rewarding career for those interested in helping people with foot and ankle conditions. Podiatrists, also known as doctors of podiatric medicine (DPMs), are medical professionals who diagnose and treat conditions affecting the foot, ankle, and lower leg. They provide a wide range of services, from prescribing medication and performing minor surgeries to providing orthotic devices and other treatments.
Podiatry can be rewarding as it can help people to improve their mobility, reduce pain, and maintain an active lifestyle. Additionally, podiatrists can work in different settings, such as private practices, hospitals, long-term care facilities, and research institutions. They also have the opportunity to work with a diverse patient population, including children, athletes, and older adults.
On the other hand, the field of podiatry can also be demanding, with long hours, a high volume of patients, and the need to keep up with the latest research and technologies. Additionally, the field of podiatry can be competitive, with a limited number of positions available in certain areas.
In general, if you have a passion for helping people and an interest in the anatomy and physiology of the foot and ankle, and you have the ability to work well under pressure and are willing to put in the time and effort required to become a podiatrist, it can be a rewarding and fulfilling career."
William P Scherer, DPM, MS, Delray Beach, FL
12/07/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: John Moglia, DPM
My office policy is that after 2 missed appointments, the patient is sent a friendly note stating that if a 3rd appointment is missed, a fee of $25 will be charged. A patient who missed her third appointment was sent a bill. She attached a note with her check payment that "you could have spent your free time doing paperwork."
I returned her check with my personal note attached, "I need your respect for my time more than I need your check." I would have returned her check anyway if there had been a note of apology. Gladly, she has not attempted a 4th appointment.
John Moglia, DPM, Berkeley Heights, NJ
|
| |
|
|
|
