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06/15/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Alan Sherman, DPM


 


The discussion regarding comparing the scope of practice of nurse practitioners vs. podiatrists if we gain a plenary license has gone a bit far afield here with talk about what podiatrists would or should be treating in their practices. The purpose of podiatrists taking the USMLE exam is to demonstrate the equivalence of our education ONLY UP TO the point that we graduate podiatry school. All doctors’ training after that point depends on the post-graduate education that they receive. Both Dr. Markinson and Kesselman are correct that the vast majority of podiatrists will not receive education that would qualify them to practice to the depth and breadth of a nurse practitioner. They will not all become medical PCPs. 


 


Most will focus on training as a lower extremity specialist. The difference for them, after passing the USMLE exam, is that they will be ELIGIBLE to apply for and be accepted for residency training programs in areas OTHER THAN foot and ankle medicine and surgery. They might even go on to fellowships in those areas. It is my hope that graduates of MD/DO schools would also be eligible to apply for and be accepted for foot and ankle residencies as well. As MD/DO students on average have higher MCAT and GPAs than podiatry student, this may raise our standards. The goal is not for podiatrists to become PCPs; it is for our GRADUATE education to become and ultimately, be accepted as equal to the MD/DOs.


 


Alan Sherman, DPM, Boca Raton, FL

Other messages in this thread:


09/21/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Podiatrists Considered Physicians and Surgeons by NY State Troopers


From: Joseph Fox, DPM, MPH


 


Podiatrists are considered surgeons and physicians and are given the privilege and opportunity to serve and support New York State Troopers.


 


I consult and use tele-medicine to refer and evaluate state troopers and their families for foot and ankle concerns that may need diagnosis and treatment by podiatrists throughout New York State.


 


Joseph Fox, DPM, MPH, NY, NY

09/16/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: ASPS Voting to Allow Non-Surgical Board Status to Qualify for Fellow Status


 


I recently decided to cancel my Fellow status with ASPS. I rejoined the ACFAS. I recently was informed that ASPS, which is a society of “podiatric surgeons”, is asking its members to vote to change its bylaws. To be a Fellow, you previously needed to be certified by ABFAS. Now they are trying to say you can be certified by ABFAS and/or ABPM (which is NOT a surgical board!). Many members should be offended that this is even up for a vote. This society would lose all of its credibility if it allows members who are not certified in podiatric surgery to be called a Fellow from a society that calls its Fellows podiatric surgeons.


 


Name Withheld

09/15/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Pamela Hoffman, DPM


 


Forty odd years ago, I sat in a histology class at PCPM where the instructor addressed the class as "ladies and doctors." He also had the occasional slide of scantily clad women in-between histology slides. It is a pleasure to watch these young women on the show doing procedures that are complex and necessary. And yes, I have been doing them also for the last 40 years. The instructor is probably dead now but I think about how far women podiatrists have come and how their success would have made him crazy. Kudos to Drs. Ebonie and Haller (Dr. Brad too).


 


Pamela Hoffman, DPM, Katonah, NY

09/14/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Steven Finer, DPM


 


I agree with Dr. Lang. I have seen this show about six times. When I would see a new patient, the initial exam was face-to-face with the patient's shoes on. The patient would remove their own socks and shoes (except for the physically disabled). Of course, I often looked at the shoes for diagnostic purposes.


 


Patients were seen separately, minors excepted, or for translation situations. Injections were always given with the patient face down. I feel these two podiatrists were chosen for their competence and also good looks. 


 


Steven Finer, DPM, Philadelphia, PA

09/13/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: "My Feet Are Killing Me"


FFrom: Joel Lang, DPM


 


I think the program "My Feet Are Killing Me" (The Learning Channel) is a great public relations entity for the profession. However, am I the only one who thinks that the doctor taking off the shoes and socks of an able-bodied patient is "weird"? My doctor does not help me undress. For one thing, the touching of shoes, which are inherently dirty, with or without gloves, contaminates anything else that might be touched.


 


When I was in practice, upon entering a room, the patient had already shed his/her footwear, but the feet were covered with a towel, so that the feet were not the first thing I met when entering the room. I was able to first focus on....


 


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

09/07/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: September is PAD Month


From: Jack Morgan, DPM


 


I would like to see podiatrists across the country emphasize the important role that they play in recognizing and treating PAD. Peripheral arterial disease has a major impact on Americans. It is estimated that the disease affects nearly 20 million Americans and growing. It is responsible for 80% of the 200,000 non-traumatic limb amputations that take place in the U.S. each year. These non-traumatic amputations often occur without diagnostic testing, meaning PAD patients are losing limbs before they receive testing to determine if limb-saving interventions are an option.


 


PAD is exacerbated by conditions like diabetes, chronic hypertension, and renal disease, which are very prevalent in minority populations. Podiatrists are the gatekeepers for this disease and it is our medical obligation to...


 


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

09/06/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven Finer, DPM


 


Given that formaldehyde is a known carcinogenic product, it is very effective as a drying agent for mosaic type warts. A pharmacist can make up a 10% solution to be used as a soak. 


 


Steven Finer, DPM, Philadelphia, PA

09/06/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Letter from Ben Walner of APMA


From: Jeffrey Kass, DPM


 


Point of reference: in the event anyone gets an email from Ben Wallner, FYI, he is the Director of Legislative Action for the APMA. The email contains links to call your Congress people to help pass the HELLPP act which is included in the reconciliation package. This is important as it would help recognize us as physicians under Medicaid.


 


I don’t know Mr. Wallner but I think it would be prudent that the email come indicating in the subject line that it is from APMA. I think colleagues who don’t recognize his name might not open the mail. I think the message is important and it is more likely the email would be opened from APMA vs. Ben Wallner. Having said that, I applaud both Mr. Wallner and the APMA on this advocacy.


 


Jeffrey Kass, DPM, Forest Hills, NY 

08/26/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: The Disappearance of N-Acetyl Cysteine


From: Robert D. Teitelbaum, DPM


 


A year and a half ago, I had a posting in PM News about my views about our incredible immune system that we have, which will save the lives of a vast majority of us against this virus. And that the government was, and in fact, has, treated this pandemic as if it was the Spanish Flu of 100 years ago which killed one in 34 people alive in this world. In contrast, this pandemic, with a world population of 7.9 billion people and an expected 4.5 million deaths will kill one in 1,755 people alive today (statistics courtesy of Google).


 


Part of the assistance we can give to our immune system is what Dr. Peter McCullough of Texas A&M University calls the "neutraceutical mix" which I listed then as Vitamin C, Quercetin, selenium, zinc, Vitamin D, and N-Acetyl cysteine (NAC). The latter is taken by the cystic fibrosis...


 


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

08/24/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM


 


Insurance companies make us jump through hoops in order to prescribe topical antifungals. We used to think that they were just steering doctors toward the least expensive generic but we found out, as you did, that they fight us on any topical antifungal. I suspect that since these are, by and large, over-the-counter products, the insurance companies do not want to pay for them. In our practice, we got around this frustrating problem by dispensing topical antifungal creams to patients. 


 


Bako, Tetra, and Blaine labs are just three of many companies that come to mind that enable us to buy and dispense these products from our offices. In this way, you are converting a lose-lose situation of wasting valuable doctor and staff time fighting with insurance companies into a win-win situation. You are not only making sure that the patient gets the proper medication, but it helps your bottom line as well. 


 


Elliot Udell, DPM, Hicksville, NY

08/24/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Reporting Disability Fraud


From: Name Withheld


 


I am by no means an expert in disability fraud but would assume disabilities are not just physical in nature. Between PTSD and other mental/emotional issues, disability claims can be for many reasons. I would not get involved. I’m sure it is very frustrating to hear your patient brag about his activities while being on disability, as much as it peeves me off to see a person with a handicap sticker park their Corvette in a handicap parking spot.


 


There is not anything good that will come out of you reporting your patient. I certainly would not confront Mr. Macho as he gets out of his handicap-parked Corvette.


 


Name Withheld

08/23/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Ludicrous Insurance Company Policies


From: Jeffrey Kass, DPM


 


I sent in an Rx for ketoconazole cream today and my EHR kicked it back stating it needed prior authorization. I used my prior auth button on my EHR and completed demographic info only to be told I had to contact the pharmacy benefits manager directly. I did so. I was told I had to answer 5 questions and answer yes or no. The questions in my opinion were moronic. 


 


1) Does the brand medication you are prescribing have a generic equivalent? I responded I prescribed a generic, not a brand and was scolded for not answering yes or no. 2) Is the medication being prescribed FDA-approved for the diagnosis? 3) Is the dosage FDA-approved? I don’t recall the remaining two questions but the fact we have to deal with BS like this is beyond my comprehension.


 


Staff, let alone doctors, should not be wasting time on mindless stupidity. Insurance companies should not be allowed to do this. The dosages in EHRs are picked from dropdown boxes and so it would conform to package inserts that are FDA-approved. If they wanted to mandate supplying the ICD-10 code, this should be done in a way it can be supplied when filling out the Rx, not having to come back to it and waste time. The mindless bureaucracy at play in modern day medicine is beyond ludicrous.


 


Jeffrey Kass, DPM, Forest Hills, NY

08/20/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Jack Ressler, DPM


 


I have purchased new MTI and Midmark chairs. Both are very good but Midmark is the best. I also purchased a used Midmark 417 chair and must say that it is still giving me maintenance-free operation. A good rule of thumb would be to purchase a good used, top brand chair. If you look at Midmark, DO NOT purchase an hydraulic model. There are still some out there but the maintenance is very costly, not to mention difficulty in getting parts. Stay away from other models.


 


Again, there are several available at good prices but in the long run, you will be dumping hard earned money into a poor functioning chair. If purchasing used equipment, try to deal with a company with a good reputation. Remember, as the saying goes, "you get what you pay for." 


 


Jack Ressler, DPM, Delray Beach, FL

08/20/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Slip and Fall Prevention


From: Keith L. Gurnick, DPM


 


Podiatry has taken such an interest in slip and fall prevention for our patients and the public, with the implementation of gait training, physical therapy, muscle strengthening, shoes, orthotics, and AFOs, when indicated and medically necessary. Every one of our patients who sustains falls does not suffer from pre-existing conditions such as drop foot, peripheral neuropathy, or flexible forefoot valgus.


       


Here is a link to a site that includes other ideas we should incorporate into our discussions with patients and family members to help prevent slips and falls. This is even more relevant, especially for otherwise healthy elderly patients, but also for our patients who are suffering or recovering from strokes, hip or knee replacements, or have conditions that affect stability and gait issues like ALS, MS, and more.   


 


Disclosure: I have no affiliation with EMC Insurance Company.


                                                        


Keith L. Gurnick, DPM,  Los Angeles, CA

08/19/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Bree Wright, RN


 


My name is Bree Wright. I am a registered nurse, an advanced nursing foot care instructor, and I develop curriculum for advanced nursing foot care programs here in Canada. I’ve been practicing in clinic for over 20 years and have been asked to share with you my findings regarding Onyfix. 


 


In my position, I am frequently asked to review new products or technologies and assess if I feel they would be beneficial in foot care and podiatry practices... 


 


Editor's note: Bree Wright's extended-length letter can be read here.


 


Disclosure: Bree Wright, RN is Director of Clinical Education for ZFT, a distributor of Onyfix.


 


Bree Wright, RN

08/18/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Lancing Malusky, DPM


 


I, too, marvel at the advancement of our profession. When I graduated OCPM in 1974, the only post-graduate program I could get was a preceptorship under Dr. Martin R. Taubman, DPM in Dayton, Ohio (residency availability was only around 40%). We took over a CNC clinic at Cincinnati General Hospital.  With much kickback from Ortho, we gradually were "allowed" to do hammertoes and bunions in the OR. We could then sneak in Tailor's bunions, through the schedulers' lack of awareness. At that time, though, the middle 3 metatarsals and neuromas were not allowed. I ran the podiatry department, a division of the surgery department, from 1979 to 1998, carrying on the fight for full DPM recognition. As of today, UC has full clinical privileges and residency status.


 


Lancing Malusky, DPM, Dayton, OH

08/17/2021    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: The Building Blocks of Podiatric Medicine and Surgery


From: Spencer F. Dubov, DPM


 


As a new podiatric surgeon fresh out of a residency program about to perform total ankle replacement in the OR of a first class teaching hospital, one has to pause for a moment to wonder how podiatric medicine has evolved over the past 75 years to arrive at this highly specialized and skilled profession as we know it today.


 


Let us begin by discussing the role of the chiropodist, often mispronounced and demeaned as “sheeropodist” instead of “kiropodist” when the educational process involved three years of training (the 4-year program began by the time I began in 1956) and hospital privileges were extended to those who were willing to adhere to the restrictive admonition of “no bloodletting”, another insulting stand by our medical brethren, but particularly the orthopedists who were...


 


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

08/13/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Robert Schwartz, CPed


 


To prevent tripping, smooth leather tips (toe pieces) can replace the shoe’s outsole material at the distal end. Sanding off ¼” of soling material at the toe area of the outsole (if thick enough) is a simple at-once, reproducible option. Start with a pair of his own shoes, that he is otherwise able to wear. There is commercially available, ready-made, forefoot (toe-only) rocker soled, lightweight and stable walking shoes, with fairly smooth outsoles in multiple widths. Your local comfort, sit and fit shoe stores should be able to help.


 


Robert S. Schwartz, CPed, NY, NY

08/05/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Jeffrey Ross, DPM, MD


 


According to the APMA Disinfection and Sterilization Guideline Recommendations for Podiatric Physicians, reusable podiatric medical instruments that are heat stable and have the potential to break intact skin during ordinary use (e.g., nippers, forceps, splitters, curettes) should be ideally sterilized using steam rather than chemical disinfectant.


 


The disinfection guideline was updated in 2019 and was developed based on the “Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008” from the CDC and the “Guide to Infection Prevention for Outpatient Podiatry Settings” from the Joint Commission.


 


I urge Dr. Curd and any podiatric physician who has questions about best practices for instrument disinfection to consult this useful guideline, available by clicking here


 


Jeffrey Ross, DPM, MD, Houston, TX, Chair, APMA Clinical Practice Advisory Committee

08/04/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Myron Bergman, DPM, Estelle Albright, DPM


 


There is only one gold standard. Buy yourself an autoclave, enough sets of instruments to cover your busiest day, and sterilize them properly every day.


 


Myron Bergman, DPM, Bridgewater Township, NJ, 


 


How would you feel if your dentist used cold 'sterilization' methods at chair side? Even pedicure salons use autoclave methods for their instruments. In this day of multiple infectious agents transmissible in a medical office, shouldn't the gold standard be autoclave? You could ask your affiliated hospital or medical center to autoclave your instruments. Or buy an autoclave. Safety first. I think it would be hard to support a malpractice claim if cold sterilization instruments were the vector for transmission of an infection to a patient.


 


Estelle Albright, DPM, Indianapolis, IN

07/23/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Charles Morelli, DPM


  


As no one else has commented, I guess it is I who has a problem with this ad. It is yet one more thing that I shake my head at as to how our profession is portrayed in the media.


 


Here we have a podiatrist (an actor) who is not only examining a patient’s foot and he still has his socks on, but then quips “have you read any good books lately?" I would have preferred the doctor/patient interaction to have been different as this could have been done so much better. 


 


Charles Morelli, DPM, Mamaroneck, NY

07/23/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: David Secord, DPM


 


I have a brother-in-law who did a dental residency in Richmond, VA to specialize in endodontics. During an interesting conversation with him some years back, he explained that if you are trained in endodontics, you are not allowed to do general dentistry and could be disciplined if caught doing so.


 


I don't know how this is legal, as it seems like restriction of trade to me, as someone who does a root canal can certainly fill a cavity or make braces. As such, if his claim is true, that is NOT the model we want for our profession.


 


The humorist Will Rogers had a quip he would share, which goes as follows: "The World of medicine has become absurdly specialized. I went into the office of an eye doctor and told him 'doctor, I have something in my right eye. You have to help me'. The doctor responded 'I'm sorry, but I'm a left-eye doctor.'"


 


David Secord, DPM, McAllen, TX 

07/22/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Connie Lee Bills, DPM, Allen Jacobs, DPM


 



I agree wholeheartedly with Dr. Udell. I am non-surgical now and I do refer surgeries to my local colleagues. I see the notes come back with non-surgical care having been done, sometimes duplicating all of the conservative measures I tried before the referral. That can be disheartening for myself and my patient.


 


Connie Lee Bills, DPM, Mt Pleasant, MI



 


If podiatry follows the DDS/MD or the DMD/MD degree, the path requires 6 to 7 years. It is achievable with a participating medical and podiatry school. The question is whether a student, then resident, will invest the required time and effort to do so.


 


Allen Jacobs, DPM, St. Louis, MO

07/21/2021    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM


 


It would be nice if podiatric surgery could mimic oral surgery in the way that oral surgery relates to the rest of the dental profession. To be specific, oral surgeons would not be caught dead filling cavities, cleaning teeth, or making crowns and bridges. Podiatric  surgeons, on the other hand, do general podiatry as well as foot and ankle surgery. This prevents non-surgical podiatrists from making referrals to foot and and ankle surgeons because the likelihood is that the generalist would never see that patient again.  


 


It would be nice if podiatry could give birth to true specialists who perfect and practice their specialty and enable general podiatry to exist as a whole and complete separate division of our profession. 


 


Elliot Udell, DPM, Hicksville, NY

07/19/2021    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Zocdoc’s Portrayal of Podiatry 


From: Alan Sherman, DPM


 


It’s always interesting to see how popular culture is portraying your medical specialty. Podiatry has, for the last two decades, been the specialty that people are at ease talking about. Is that because they find it funny or just, accessible? Imagine this Zocdoc commercial with general surgery, oncology, or ENT as the consumer focus.


 













Click on photo to watch Zocdoc ad



 


BTW, Zocdoc also has ads targeting conditions like migraines and back pain, without mentioning the specialty that you need to treat them. Should we be pleased that they mentioned us by name? You bet we should!


 


Alan Sherman, DPM, Boca Raton, FL
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