Podiatry Management Online


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From: Ivar E. Roth, DPM, MPH


Dr. Slowik is correct concerning perception by our peers. If you act like a physician and think like one, than you are one. If you walk the walk and talk the talk, others will see you as you want to be seen. I personally have carved out a niche in my community as a concierge podiatrist and it is working wonderfully. You are what you believe you are. Think positive and the results will follow.


Ivar E. Roth, DPM, MPH, Newport Beach, CA

Other messages in this thread:



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



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



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



From: W. David Herbert, DPM, JD


Over two hundred years ago, Thomas Jefferson predicted that judges would become little dictators. If we are talking about the standard of care in a medical malpractice case, one of these little dictators will be the one who will be in charge of who will be allowed to testify regarding the standard of care in any malpractice case. In some states, a non-doctor can testify about the standard of care of a doctor.


You also must remember that becoming a judge really depends on your politics and has nothing to do with your knowledge of science or medicine. Just something to consider when discussing standard of care.


W. David Herbert, DPM, JD, Billings, MT



From: Dennis Shavelson, DPM, CPed


Resistance Training (RT) is one area where there has been a dirth of reviewable evidence for the “Standard of Care” (SOC) for decades. This has led to the ability of those producing and marketing their equipment and methodology to claim “SOC” in the marketplace. Company websites and blogs claim that their free weights, machines, weighted wearables, and resistance bands are the best to own without justification.


Some years ago, I published a 21 page meta-analysis of RT: which reviewed the current evidence for all forms of resistance training. There have been 1,300+ readings of that article on ResearchGate alone to date. I have advocated for change in the misrepresentation of resistance training standard of care exactly as Dr. Jacobs suggests, with some level of success.


Dennis Shavelson, DPM, CPed, Tampa, FL



From: Carl Solomon, DPM


This goes beyond commercial entities and advertising. Several years ago, I attended a presentation at one of our seminars. The speaker was a nationally recognized colleague and I believe the topic was infections. He posed a question to the audience (I don't remember specifically) was either "Do you ALWAYS order antibiotics for infected ingrown nails?"...or "Do you ALWAYS get a C&S before ordering any antibiotics?"...or  "Do you ALWAYS get x-rays for an infected ingrown nail?"...or "Do you ALWAYS administer Abx prophylaxis prior to bone surgery?" The specific question isn't the issue. He asked for a show of hands indicating who does. Of an audience of probably 150 attendees, very few raised their hands. He then scolded us, saying that the "standard of care" was that we should ALWAYS do that. 


Excuse me...didn't the response of that audience (assuming it's a fair representation for this locale) just define that the standard of care is that we do NOT always have to do whatever it was? How can someone who comes from a couple thousand miles away define what OUR standard of care is? When we let these things go unchallenged, there can be scary ramifications.


Carl Solomon, DPM, Dallas, TX



From: Jim Rief


Gill Podiatry has sodium hydroxide in stock.


Disclosure: Jim Rief works for Gill Podiatry. 


Jim Rief, Strongville, OH



From: W. David Herbert DPM, JD


Because I am close to 80 years old, I would personally not be interested in a degree change. Because I have a wife who has taught in several college level nursing programs and two cousins who have practiced dentistry for decades, I have a little different perspective about what is going on in medicine. We must look at the whole picture and must look at the whole forest and not be caught up with looking at just a few trees or maybe a few large bushes.


The big issue is that NP equals DO and MD. I can guarantee you that NPs will never be required to pass any tests that DO and MD students have to pass. Yet, legislatively at least in a number of states, they are considered equivalent to MDs and DOs. I have heard several well-known politicians state that robots and computers will replace physicians. Our students have been dumbed down by our school systems for decades! 1984 came about just 30 or so years late.


W. David Herbert DPM, JD, Billings, MT



From: Paul Kesselman, DPM


Having shared an office with a PCP for over thirty five years and practicing podiatry for just a tad longer than that and being a patient of a PCP and a myriad of medical/specialists, I feel not only qualified but obligated to respond to this thread. There is no way that I, as a practicing podiatrist, whether I had an MD/DO or DPM degree want to be compared to an NP, nor can I state that I am as qualified as they are to provide primary care. I have seen not only what the PCP does but what the NP does in the primary setting as both patient and provider. I have also been to four different specialists for a variety of routine issues (nothing serious fortunately) in the last two months.


When they ask me about or I state certain things which are related to primary care, the MD/DO specialists immediately state that's not their area of expertise. The same is true for the NP in...


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



From: Bryan C. Markinson, DPM


Dr. Herbert thinks that podiatrists should be able to provide primary care, right now! Really Dr. Herbert? He supports his belief by reminding us that nurse practitioners provide primary care. Indeed, they do. At least 20% of my patients in my hospital-based practice are cared for by nurse practitioners for their primary care needs. That is also increasing rapidly. I am all for advancing our profession, and it is not easy to be critical of anyone's position that supports advancement without appearing to be obstructionist. I'll risk it.


Dr. Herbert's assertion that "we can sure argue that our training in the medical and surgical sciences are much more intense and in depth than that of nurse practitioners" is not only preposterous but an embarrassment to have to read in a public forum. There is no valid way to even compare the educational experience of the NP and the DPM when the eventuality of providing primary care is the parameter being discussed.


I know not one single podiatrist, practicing as a podiatrist, or any RRA trained podiatry resident, who can perform as a provider of primary care, or come close to the knowledge and skill of a nurse practitioner engaged in the day-to-day practice of primary care. But don't worry Dr. Herbert, I know not one foot and ankle orthopedist who can perform primary care either or who would ever assert that they could be as good as a nurse practitioner providing primary care. Incredulous proclamations are not the way to go.


Bryan C. Markinson, DPM, NY, NY



From: Elliot Udell, DPM


Comparing podiatric physicians to nurse practitioners and then asking why DPMs should not be allowed to practice full body medicine if NPs do it all day long, is an unfair comparison. Why? From the get-go, registered nurses are highly trained in full body medical practice. In the hospitals, they have and always will be responsible for general medical care under physician orders, 24/7. Nurse practitioners have to have a masters or doctorate on top of that intense training. According to the NP association, nurse practitioners see over 1 billion patients a year for general medical care. These men and women are highly trained. 


On the other hand, we DPMs are better trained in the medical and surgical aspects as it pertains to the lower extremities. The bottom line is that if I am going to my allergist or going to urgent care, I have no problem being evaluated by a nurse practitioner. At this point in time, I would have a problem being evaluated by a colleague of mine for a non-podiatric problem. Should the clinical training for podiatrists change and the amount of general medical clinical hours become on par with nurse practitioners, MDs, DOs, and well trained PAs, then I would have no problem allowing a fellow podiatrist to evaluate me for a GI, cardiac, or any other medical problem.


Elliot Udell, DPM, Hicksville, NY



RE: The Passing of E. Darryl Hill, DPM


Dr. E. Darryl Hill, 71, of Unity Township, departed this life on Wednesday, May 26, 2021 at UPMC Shadyside. Darryl attended Boston University where he shined on the football field and was named team co-captain in 1970. Darryl played in the NFL for the New York Giants and the Houston Oilers.


Dr. E. Darryl Hill


Upon graduation from the Ohio College of Podiatric Medicine, Dr. Hill began a podiatry practice that spanned more than three decades across western Pennsylvania, including offices in Indiana, Greensburg, and Meyersdale. Darryl had an immense personality and presence, lighting up any room he walked into and making those who met him all the better for having done so. 


Source: [5/29/21]



From: Eric Lullove, DPM


About three years ago, I did the overhaul of my phone system. I got rid of my outdated analog system and went with a PolyCom digital system provided by my Fiber Internet provider. Every prompt created and introduction message is done digitally. I hired via Fiverr, a voice actor to do my introduction message and background music from Audioblocks.


Every prompt for afterhours, billing, prescription refills, consultations, and emergency calls is handled via the digital system. Voicemails are transcribed and sent to my phone via MP3 format. I have no further need for an “answering service” as it is already built into my digital communications package that I pay monthly for. The package includes 4 phones, 4 lines, a dedicated Internet fax server, and 100MB dedicated fiber optic Internet.


Eric Lullove, DPM, Coconut Creek FL



From: Allan Weiss, DPM


I completely agree with Dr. Sussner. I have been vaccinating, specifically in “communities of need”, and have found it to be an amazing, profoundly good experience! I highly recommend it.


Allan Weiss, DPM, Orange, CA



From: Ivar E. Roth DPM, MPH


As one of America’s first podiatrists to go fully concierge, I think I can weigh in on this topic with authority. Additionally, as a pioneer in concierge medicine, I was also the chapter president of the American Academy of Private Practice Physicians in Orange County, which recognized me as an equal to the MDs. The first three years after I dumped all insurances including Medicare, my income dropped around 70%. Those were trying years but I knew I had to do what it took to break away from the insurance addiction. After about 5 years, my income was back to the previous level. The key to going concierge is to excel at what you do and offer excellent customer service. But that is NOT enough. I ended up reinventing myself and my services a few times. 


Now I offer unique services, including Saturdays, that patients cannot receive anywhere else. There is a good demand for my services and the demand is growing rapidly. The future is bright for the concierge model and those who are willing to take the risk and benefit from the reward. It was not an easy road but at the end of the day, I would not do it any other way. I am my own boss, I depend on no one, and NO ONE dictates to me how to see patients or run my office. Podiatry is great and wonderful and I hope my colleagues will someday embrace this model.


Ivar E. Roth DPM, MPH, Newport Beach, CA



From: Barrett Sachs, DPM


I would like to thank Dr. Sherman for clarifying my statement regarding Florida CME online requirements. At no time did I give any false or misleading information. I was just reporting the facts as they currently stand. Kudos to FPMA for revising their demands.


Barrett Sachs, DPM, Plantation, FL



From: Bret Ribotsky, DPM


I feel I need to set the record straight on Dr Zinkin’s letter about Florida and the FPMA’s request to the Florida Board of Podiatric Medicine. Please see the minutes (page 4 under public comments) or listen to the audio file. You can see clearly that Dr. Zinkin and FPMA wanted to require in-person attendance and it was I who spoke up and requested all credits for this renewal cycle to be available on-line or in any way without a restriction. 


Everyone should also be aware that FPMA charges each member well over a few hundred dollars each year for providing CPME credits. Nothing of value is ever free.


Bret Ribotsky, DPM, Boca Raton, FL



From:  Alan Sherman, DPM


The comment made by Cary Zinkin, DPM and the executive officers of the FPMA in response to this topic is not the complete story, and Dr. Sachs comment that they are replying to contained no misinformation. Zinkin leaves out that on Oct 9, the FPMA issued this announcement via email to FPMA members: “FPMA, on behalf of our members, sent a letter requesting the Board consider modifying the current CME rule to allow for up to 20 virtual hours during this biennium.” Since the Florida Board of Podiatry requires double that, or 40 hours of CME each biennium, the FPMA clearly first requested that the Board only allow 50% of CME to be earned online, and was granted that, as Dr. Sachs correctly states. 


It now appears in this comment that the FPMA has NOW revised their request, and has NOW requested that ALL CME required by the Board be allowed to be earned online. Good for them…they have come to the right decision after an early mis-step. And it should not be forgotten that for years, the Board only allowed 20% of CME to be earned online and it was only in response to COVID that the FPMA attempted to correct this regressive policy of the Board. It is my opinion that podiatrists in all states should have the freedom to choose how they obtain all of their CME. 


Disclosure: I co-run PRESENT e-Learning Systems 


Alan Sherman, DPM, Boca Raton, FL



From: Lisa Schoene, DPM


There is a compounding pharmacy that we use located in Deerfield and Roselle, Illinois called Mark Drug. We receive the solution and then we prepare it by mixing into our lidocaine bottle to form the mixture. The price is very reasonable (less than $100) and they are licensed in Illinois, Indiana, and Wisconsin. I reached out to the pharmacist at Mark Drug and they are happy to assist podiatrists in any of those three states. They can discuss the details and set up an account for the individual practice.


Lisa Schoene, DPM, Parkl City, IL



From: Arnold Signer, DPM


Dr. Rubin questions why our state associations charge a fee to obtain CMEs for their webinars. Granted, we are experiencing unusual circumstances that we have never before encountered, due to the pandemic. However, there is a solution; particularly for the larger states. Only a portion of the income required to operate a state association and the attendant costs of representing its members and protecting their ability to practice comes from dues income. 


A large part of the remaining income is derived from educational seminars and, yes, webinars. Having been involved in running educational meetings, I know that there is no guarantee as to projected registration for a seminar. However, what if every member of an association shared in the cost of staging a meeting? In the late 1980s, the Florida...


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



From: Dennis Fassman, DPM, Robert Scott Steinberg, DPM


THIS is the source for Dr. Secord's (incorrect) discourse on face masks.


Dennis Fassman, DPM, Westbury, NY


Once again, Dr. Secord seems to leap, without looking first. His post is, on its face political, outrageous, unscientific, and unprofessional. The use of right-wing physician Dr. Ted Noel, who is no longer licensed, and whose theories have been disproven, seems to show desperation on Dr. Secord's part. Let's fact check Dr. Noel. The truth is, masks work.


Robert Scott Steinberg, DPM, Schaumburg, IL



RE: Fauci and Double Masking

From: David Secord, DPM


I was pilloried by a number of individuals the last time I pointed out that the actual (not make believe) science demonstrates that cloth and O.R.-type masks are ineffectual for impeding the aerosols which carry viruses and that the grand majority of studies quoted by the cognoscenti are talking about droplets and not aerosols and, therefore, have no relationship to the question of whether masks work. 


Now that media darling and pathological liar Anthony Fauci has decided that if one worthless mask isn't enough, two (or maybe a dozen) would be a lot better (and the CDC confirmed this absurdity) and has decided that you still need to wear a worthless mask even after receiving the vaccination for the COVID-19 virus (which makes absolutely no sense). I thought it was time to take another whack at it. I've attached a nice article about the subject, which no one will read. It has links to several studies by Xiao and Konda (which no one will read) which conclude that masks have no effect upon transmission or reception of the aerosols which carry viruses.


Mask wearing has had no effect upon the contagion rate, death rate or transmission of the virus. Lockdowns have had no effect, except to destroy the economy. Social distancing has no effect upon the area under the curve of a closed set cohort. It is time to stop being sheep and believe the (actual) science.


David Secord, DPM, McAllen, TX



From: Leonard A. Levy, DPM, MPH


The comments by Glen N. Robison, DPM are absolutely on point. I would be glad to be part of the debate he suggests. The focus should not only be on our colleagues from both the allopathic and osteopathic community but also, equally important, on the podiatric medical profession including the podiatric medical education community -  the sooner the better. 


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



From: Richard M. Maleski DPM, RPh


Thanks to Dr. Jacobs for including this paper on the value of primary foot care services. It does point out that other medical practitioners also recognize the importance of such services. However, to my mind, it points out an even more poignant observation; that is that podiatrists are only considered for primary services, such as nail care and ulcer care. The authors specifically point out that other services, such as rehab and orthotics should be referred to physiatrists; and bone and joint problems, including surgery, should be referred to orthopedists. Granted, this article was written in Great Britain, but published in the U.S. 


This is just another example that our profession needs to pursue true equivalence with our MD and DO colleagues. Otherwise, we will continually be responding to such biases on a case by case basis.


Richard M. Maleski DPM, RPh, Pittsburgh, PA



From: Joseph C. D’Amico, DPM


Here’s a few of my pearls that I don’t think thus far have been mentioned. It should go without saying that unless there has been a thorough biomechanical examination of at least the lower extremity along with observational gait analysis, these suggestions of and by themselves are incapable of effecting optimum alignment, performance, and symptom resolution.


1) Neutral subtalar position plaster impression casting in the supine position. This position, as recommended by Drs. Root, Weed, Orion, Blake, Kirby, Valmassy, Smith, Scherer, and countless others allows a true representation of the...


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

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