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From: Brian Kiel, DPM


There may be a "climate" of gender equality but that does not mean there is equality. There is a "climate" of racial equality but climate does not mean equal treatment. Dr. Mendoza, as a woman, is much more able to validly claim discrimination without written substantiation (which of course does not exist). There is unequal treatment of people due to gender, race, or religion. To deny that this occurs is a result of the "privilege" of being a member of a class that does not have to be concerned about discrimination. 


Brian Kiel, DPM, Memphis, TN

Other messages in this thread:



From: Ben Pearl, DPM, Stephen Peslar, BSc, DCh


The medical world is a big interconnected ocean; even more so in the age of the Internet. My experiences have led me to the conclusion that teaching is noble, but it is best to know your environment. Know whether you are swimming with the dolphins or the sharks.


Ben Pearl, DPM, Arlington, TX


I worked in a publicly funded foot clinic with 2 other podiatrists. We provided hands-on training to nurses. It seemed to go well. When 2 podiatrists retired, applications for funding 2 positions were filed with management, while the podiatrist and 3 foot care nurses were still at the foot clinic. Then a budget cut occurred and the podiatrist was downsized. Now there are 3 foot care nurses at the foot clinic. They refer patients to their PCPs when a foot problem or lesion requires advanced treatment or examination or radiographs. In retrospect, perhaps if the podiatrists did not train the nurses, then 3 podiatrists would still be working at the foot clinic. 


Stephen Peslar, BSc, DCh, Toronto, Ontario, Canada



RE: WA Podiatrist Trains Nurses in Medical Grade Footcare (Bryan Markinson, DPM)

From: Bret Ribotsky, DPM, Sheldon Nadal, DPM


Editor's note: Dr. Ribotsky's video response can be viewed by clicking here


I agree with Dr. Markinson’s point of view. I think that by sharing your knowledge with other medical professionals, you are more likely to gain a fan and more referrals than lose referrals.


Sheldon Nadal, DPM, Toronto, Canada



From: Eddie Davis, DPM


The running shoe industry has been able to save money on shoe manufacturing by moving away from structured shoes to shoes with soft single material midsoles. The industry goes through great lengths to justify why they have done so, basically telling us that what we know about biomechanics does not matter. Golden Harper, the creator of Altra shoes was interviewed by Ben Pearl, DPM. Harper stated, "Pronation, supination, and stability categories were not relevant in determining the proper running shoe." Harper described his shoes as being designed more for the natural way that we run.


What is the "natural way that we run?" Does placing a pillow under our feet not change the way we run? Are we to assume that the way each person runs is biomechanically efficient and does not lead to pain nor pathology? I think we know the answers to those questions. Hype from the companies selling overly soft, unsupportive, and unprotective shoes is not something we need accept.


Eddie Davis, DPM, San Antonio, TX



From: Mark K Johnson, DPM


I could not agree more with Dr. Morelli‘s comments and assessment of the (my words) dumbing down and reality show subjects that are held up as examples of the expertise of our profession. The APMA and its components should focus on the elucidation to the public of our training, scope, and value of the medical, orthopedic, and surgical services that podiatric specialists offer in the 21st century.


Mark K Johnson, DPM, Bakersfield, CA



From: Keith Gurnick, DPM


Mechanically-induced back pain can be reduced/improved or alleviated with better postural mechanics and improved lower extremity function in standing activities and during gait with the help of custom prescription foot orthotics. This usually requires a combination of treatment modalities including stretching, core muscle strengthening, activity modification, and foot orthotics.


An excellent test to see if custom orthotics might be successful is to first try a properly applied low-Dye tape strapping(s) and when indicated also concurrently the use of a unilateral measured heel lift inside the shoe for limb-length discrepancy. Podiatrists who dispense orthotics should be checking for LLD on exams. If the temporary taping and a heel lift helps, I have found that this is a good predictor that custom prescription orthotics will help as well. This two-step approach is quite understandable to our patients who are looking for relief of their back pain. These patients will often try anything but unfortunately they become disappointed when poor outcomes and results don't meet the hype and their expectations.


Keith Gurnick, DPM, Los Angeles, CA



From: Joseph W. Cavuoto, DPM


Lowell, best wishes on your retirement. Thanks for your direction during my Northlake residency; it made the transition to podiatric practice easy. My family and I will always be grateful. We certainly enjoyed your family's hospitality during the year, especially at Thanksgiving for the out-of-town residents and families. Your twenty-four hour arthroplasty was a real gift that patients loved, including Jane my wife.    


Joseph W. Cavuoto, DPM (Retired), Dix Hills, NY



RE: CMS Overhauling Medicare Fraud Audit Process (Hal Ornstein, DPM) 

From: Melissa Lockwood, DPM


Dr. Ornstein makes good points regarding RAC audits, but there are a few things to clarify. In reality, the government has not focused on "random" audits in quite some time. They have been specifically targeting those providers who lie outside of the standard deviation of the bell curve for any given procedure - which in many cases is ANY one of us depending on if we see "more" or "less" than a particular type of patient - i.e. diabetics with ulcerations.


That said, it's critical that we all have access to the same information that CMS has in order to remain enlightened and to be aware of billing trends. I use my EHR system's  (TRAKnet) Code Audit Compliance feature (which aggregates and reports my utilization of codes  benchmarked against 2000 other users), as well as the information I glean from their monthly Virtual Practice Optimization (VPO) analysis. It's invaluable in identifying both overutilization as well as under-utilization across all of my providers in the practice so we can evaluate and adjust our coding habits accordingly.


Melissa Lockwood, DPM, Bloomington, IL



RE: CMS Overhauling Medicare Fraud Audit Process (Hal Ornstein, DPM) 

From: Bret M. Ribotsky, DPM


I believe Hal’s way is too difficult. I suggest that everyone go to this website and look up "podiatry" in their city, and drill down on the top twenty codes that your competition are using, and you can easily see where you are. This data base is incredibly valuable on many issues such as trends that others are appreciating in your locality that you may be missing.


It's also fun to see which doctor in your community is making the most money. On the other hand, what an incredible invasion of privacy! There's no website to look up what patients are receiving from the federal government in assistance; it's only the doctors who must share everything. 


Bret M. Ribotsky, DPM, Boca Raton, FL



From: Thomas Graziano DPM, MD


As Dr. Ribotsky points out, it's a sad commentary on not only our profession but the insurance industry. The fact that one has to "bend the rules" to help patients get covered by the Teflon coated insurance providers is the travesty here. When has anyone seen one piece of legislation going against any insurance company in this country? Never. Because their lobbyists are all over the policymakers like a cheap shirt, lining their pockets with gold.


It's over for healthcare providers in this country, at least for those who continue to take the abuse. Certainly if everyone dropped out of network, these issues would go away. Think about it. No that won't happen, so docs will continue to bend over and take it.


Jail time for nail care. Ridiculous. It would be helpful to the younger practitioners to have a clear understanding of what "qualifies" for nail care. For those with the exact criteria, list it on this forum. It would be a service to your fellow colleagues and keep them out of the "watchful" eye of the insurance companies and government.


Thomas Graziano DPM, MD, Clifton, NJ



From: Robert Boudreau, DPM


“We cannot move forward in the new healthcare era as podiatrists with a limited license to practice" - Sev Hrywnak, DPM, MD


Correct me if I am mistaken, but isn't the PA (Physicians ASSISTANT) yet another "Limited License"? Who came up with this ridiculous idea? I'd like to offer other "Limited License" degree selections: DPM-DG dog groomer, DPM-BC barber college, DPM-SS salon stylist (and with additional training HC &P hair coloring and perms), DPM-LS legal secretary (or with a fellowship, DPM-LA legal assistant). Or better yet, just apply to nursing school, get your RN degree, and get additional training to be a nurse practitioner, DPM-FNP.


Perhaps many would want to earn additional degrees as some already have, producing Joe Insecure, DPM, BC, SS, HC&P, FNP. The problem with that is, those are all still LIMITED LICENSES. Here is my suggestion: If one wants to pursue an MD degree, apply to medical school, get accepted, work hard, and earn an MD degree. Don't bring the whole profession down by offering physicians ASSISTANT degrees.


Robert Boudreau, DPM, Tyler, TX



From: Joseph Borreggine, DPM


This happened once before under a GOP governor back in the '90s for 6 years in Illinois and then just recently in 2012 under the Illinois SMART Act where 64 health agencies  or medical professions including dentistry, optometry, psychiatry, and podiatry were cut or had services reduced in the Medicaid program, all in the name of saving money. Of course, we knew differently. The Illinois legislature looked to eliminate podiatry completely, except for children 19 and under, but an IPMA delegation including our esteemed executive director, Michael Hriljac, DPM, JD, testified in front of the Illinois legislature back in 2012, and fought to have any diabetic patient on Medicaid to be seen by a podiatrist. Recently, we lobbied the Speaker of the House and got the Illinois House and Senate to reverse their decision. So, where was the Illinois State Society? Right on top of the issue every moment and step of the way! 


Joseph Borreggine, DPM, IPMA, Health Care Advisory Committee Chair,



From: David G. Armstrong, DPM, MD, PhD, Hal Ornstein, DPM


Five thousand is a big number. It constitutes a full surgical career. It would be double a consecutive games streak for a hall of fame ballplayer. Please allow me, however, to offer another number into this mix: one. One man has, through persistence and ability created the equivalent of our specialty's bulletin board. This one thing will outlive him and us. Hopefully, the impact it has and will make will allow all of us and many of our mentees to better touch the next 5000 people they see in their offices and clinics throughout the world. Congratulations, Barry. Our specialty is better with you in it.


David G. Armstrong, DPM, MD, PhD, Tucson, AZ


5,000 issues of PM News is monumental! A landmark reflecting the commitment of Barry Block to our podiatry community and also need to recognize the frequent contributors who spread such a wealth of clinical and practice management knowledge. All this makes our profession all the stronger and united. 


Hal Ornstein, DPM, Howell, NJ


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