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01/12/2022    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Suggestions to Online Lecturers


From: Bret Ribotsky, DPM


 


I want to issue a very public thank you to all those organizations and people who stepped up in the past two years to allow DPMs to earn their CPME credits online. Personally, I feel we all learned a lot about online lectures. 


 


As one who has given 800+ live lectures in the past 30 years, I feel I can offer many of the online speakers a few suggestions. 1) Don’t talk down into your laptop camera (raise it up on books or a shelf) as looking up your nose it not that pleasant. 2) Stand up when talking, as this allows energy and passion to flow to your audience. 3) Pay attention to your background (lights and fans can be distracting). Everyone, please feel free to add to this list, as this way of learning will continue to be the future.


 


Bret Ribotsky, DPM, Ft. Lauderdale, FL

Other messages in this thread:


08/12/2022    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Jeffrey Kass, DPM


 


I respectfully disagree with Dr. Kravitz’s definition of board certification. How does certification “help to protect the public”? Does this mean that board certified doctors don’t or can’t commit malpractice? “It informs the public about physicians who have specific training and education in a specific subject area” – what does this mean? Is the board the doctors a P.R. firm? If a doctor wants to inform the public about certain areas of expertise, then let the doctor advertise it. Does being board certified in podiatric surgery indicate to the public that the doctor specializes in flatfoot reconstruction? I think not. That is the doctor’s responsibility of sharing with his colleagues or letting referral sources know what he is capable of.


 


Podiatry residency has become standardized to a 3-year program. All this training should be enough to “protect the public”. If it is not, then the resident should not graduate. These tests do not test a doctor’s integrity or dexterity in an O.R. They do not test how quickly a doctor can think while a tourniquet is on and a procedure is not going as planned. Board certification unfortunately does not measure what is really important. It has been an unnecessary cost to the doctor. With the advent of a 3-year residency training, we should do away with the boards, or make it an exit exam for podiatry residency programs. If you want to do a 5-year refresher exam of some sort, fine, but don’t tell me the current way these certifications are done do anything to protect the public. 


 


Jeffrey Kass, DPM, Forest Hills, NY

08/11/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From Steven Kravitz, DPM


 


Certification is a method to help protect and inform the public about physicians who have specific training and education in a specific subject areas. This requires that recertification be completed on a regular basis to demonstrate the physician is up-to-date on current standards. As an example, the Academy of Physicians in Wound Healing/Council for Medical Education and Testing does not offer a lifetime certificate. 


 


Medicine is a consistently evolving science and what may have been acceptable in previous years changes as the science advances. ABPO had announced for a number years that the cut off year for lifetime certification was going to occur in 1995. Not moving in that direction would have invalidated the entire certification process for the ABPO. These are standards accepted by medicine across-the-board including all aspects of allopathic medicine.


 


Steven Kravitz DPM, Winston Salem, NC

08/11/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Help Increase the Availability of Naloxone


From:  Robert G. Smith, DPM, MSc, RPh


 


I am writing to urge your support as well as the PM News readership to help increase the availability of naloxone in the nation’s pharmacies and in the community at-large. Hence acting of the fourth strategy proposed by the National Academy of Science and Engineering in 2017 to “Prevent Harm”. Fentanyl and its analogs are being used as contaminates in imported illicit drugs to include marijuana as well as counterfeit legend medications putting many citizens living in the United States at risk of opioid overdose from this weapon of mass destruction. Marijuana should no longer be referred as a “Gateway Drug but a Pearly Gate Drug”.


 


For this reason and many more, I believe that additional steps are necessary to ensure that Naloxone, a lifesaving medication, is more widely available. I would like to strongly encourage action to...


 


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

08/10/2022    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: ABFAS vs. ABPM (Steven Selby Blanken, DPM)


From: Jeffrey Kass, DPM


 


I can’t blame Dr. Blanken for being sour with ABPM based on the story he shares. However, the whole idea of a lifetime certificate is a farce. If the idea of board certification is that one is being held to some grandiose higher standard, then shouldn’t they have to demonstrate such said level regularly? How can they pass an exam and then be given a “free pass” for the rest of their career. Lifetime certificates should be annulled as void and worthless. 


 


Jeffrey Kass, DPM, Forest Hills, NY 

08/09/2022    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: ABFAS vs. ABPM


From: Steven Selby Blanken, DPM


 


I have been in practice 30 years. At the time, I completed two one-year residency programs, one in POR, and the other PSR. Within 3 years upon completion of my training, I decided to get double boarded by the then ABPS in foot surgery and ABPO in foot and ankle orthopedics. At that time, only around 5-10% of the field was double certified. Eventually, ABPS turned into ABFAS, and ABPO turned into ABPOPPM, then ABPM. At some time in my career, the ABPM offered "lifetime" status with no expiration for most of its members who went from ABPO to ABPOPPM. However, for some odd reason, they grandfathered everyone but people in my board certification year (1995).


 


I wrote letters in protest to that board on why my year was not grandfathered like the years just below me. They didn't have the best answer in the world. Months later, I received a new certificate stating on the bottom that my expatriation date was now labeled as "lifetime". Therefore, I thought...


 


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

07/28/2022    

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


RE: AMA and Podiatry’s Scope of Practice (Daniel Chaskin, DPM)


From: Carl Solomon, DPM, Jeffrey Kass, DPM


 


We berate other providers (dermatologists, general surgeons, family physicians, ER doctors, advanced nurse practitioners) for their lack of expertise to adequately treat something as "complex"' as an ingrown toenail.  So does it make sense that we want to manage diabetes and gout, which are rarely stand-alone illnesses and frequently accompanied by metabolic syndrome, hypertension, renal, and cardiac issues?


 


Carl Solomon, DPM, Dallas, TX


 


I believe Drs. Udell and Kravitz missed the point Dr. Chaskin was aiming to convey in his post. I thought (possibly incorrectly) that Dr. Chaskin was attempting to offer a possible strategy to increase scope of practice where it is limited. He suggests in his last sentence – “once podiatrists become trained to prescribe medications to treat foot conditions that affect other body parts, state legislatures should allow podiatrists increased scope of practice.


 


I don’t know how realistic of an idea this is – but, I applaud Dr. Chaskin for at least suggesting an alternative.


 


Jeffrey Kass, DPM, Forest Hills, NY

07/28/2022    

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



From: Ivar E. Roth, DPM, MPH


 


I read with interest Dr. Alan Sherman’s response to Dr. Jacobs, and Dr. Markinson’s comments. While I respect the aforementioned noted doctors, they seem to want to box in our profession in what they think is our limits as podiatrists. I agree with Dr. Sherman that podiatrists are not a homogenous group. While I think the average student applying to podiatric medical school probably could not get into medical school, there are a few in every class that could easily have gone to medical school if they wanted to. I know this for a fact as my son graduated from UCLA with honors as a bioengineering major and had MCATs that would easily allow him acceptance into medical school. I am proud to say he will be a third generation podiatrist in our family.


 


I think we should allow the cream to rise to the top and allow any of our graduates who have the brains and fortitude to push the limits of their training in whatever manner they choose. If they want to manage a diabetic with a foot problem, why not if they have the training and experience. Like Dr. Sherman stated, "Let’s never become complacent and let’s continue to improve."


 


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

07/27/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Steven Kravitz, DPM


 


I question why Dr. Chaskin feels it is necessary for podiatrists to write for insulin. Internists and diabetologists do this on a regular basis and will always be much more proficient at the nuances of prescribing insulin. Medicine is best practiced when each specialty provides patient care in the area in which they were trained and licensed..


 


The DPM is very well respected, at least from my experience. I ran a podiatric surgical residency program that had as many as 35 internal medicine residents rotate through the podiatric services. The hospital approached me to do this training and my DPM degree was very well respected and recognized.


 


The quiet majority of podiatrists are busy providing good quality care with compassion for their patients. We provide services that are valuable and increase the quality of life. We share a common goal in the opportunity to network with other medical colleagues as part of the team. This philosophy provides ultimately the best patient care and a very satisfying and fulfilling professional career.


 


Steven Kravitz, DPM, Winston-Salem, NC

07/27/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Elliot Udell, DPM


 



Dr. Chaskin questions whether treating diabetes with insulin would be within our scope if the aim of our therapy would be to treat diabetic neuropathy caused by diabetes. The problem with allowing podiatrists to treat diabetes is that the training involved to properly manage diabetes is vast, and in many cases requires the training of an endocrinologist who specializes in diabetes. It’s not just insulin but many other drugs that are on the market. 


 


Could a podiatrist be trained to manage diabetes? For sure. I truly believe that with proper training, my colleagues could be trained to do brain surgery and would be good at it. At present, however, we as a profession are not trained to properly manage the entire spectrum of diabetes nor are we trained or legally allowed to do non-podiatric surgical procedures. 


 


Elliot Udell, DPM, Hicksville, NY 

07/27/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Judd Davis, DPM


 


Dr. Gurnick raises a great question I have often wondered about. How many times have you had one of these Medicare Advantage patients come to your office with no idea that they now have a copay, or that they now need a referral from their PCP, or sometimes not even knowing how or why they have been switched from standard Medicare to one of these plans!  In some cases maybe a bit of dementia is a factor, but often it seems they are never told any of this before signing up.  Maybe it’s in the fine print that no one ever reads? Why does our government (aka. all of us) pay for and tolerate this?


 


These Medicare "Advantage" plans were originally created to lessen the burden on the Medicare system and save taxpayers money. Just the opposite has happened as the paperwork and bureaucracy have increased, and worse yet, those commercial insurance companies taking this on are profiting billions of dollars/year on the taxpayer's dime. Again, why are we all paying for this?  We can and should do better.


 


Judd Davis, DPM, Colorado Springs, CO

07/26/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: AMA and Podiatry’s Scope of Practice (Allen Jacobs, DPM)


From: Daniel Chaskin, DPM


 


The definition of podiatry should allow a podiatrist to prescribe medications that may affect systemic organs, but for which the purpose is to treat a foot condition. With such a definition, podiatrists should be allowed to Rx insulin for a foot with a diabetic neuropathy. A license is not a right to Rx without training and experience. But a license opens a path for training from an internist, endocrinologist, etc.


 


I remember years ago when I asked if a podiatrist could treat PVD in the foot with Trental even if other parts of the body are affected. The response was yes, so long as a foot condition is being treated. Once podiatrists become trained to prescribe medications to treat foot conditions that affect other body parts, state legislatures should allow podiatrists increased scope of practice.


 


Daniel Chaskin, DPM, Flushing, NY

07/26/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Medicare Advantage Plans and TV Ads are Deceiving 


From: Keith L. Gurnick, DPM


 


Advertisements on selected television stations with programming geared towards seniors run continuously tempting Medicare patients to call 800 numbers to check to make sure they are getting "free healthcare plans" and "all the benefits they deserve," and  also that additional money will be added back to their "monthly social security checks."


 


Paid spokespersons consisting exclusively of older celebrities, including William Shatner, George Forman, Joe Namath, and Jimmie "J.J." Walker read similar, if not exact, scripts in an attempt to induce the elderly to phone and check their "zip code" to see if they are eligible. I can't figure out what the zip code has to do with anything, but maybe someone can help me to understand this fish hook?


 


As of November 2021, 42% of all Medicare eligible patients are enrolled in Medicare Advantage plans. Does the viewing public not wonder why there is never any mention at all during these commercials that changing to a Medicare Advantage plan means switching their traditional Medicare over to an HMO, and that most likely they will lose their network of doctors and possibly hospitals as well?  Why don't they just tell the truth?


 


Keith L. Gurnick, DPM, Los Angeles, CA

07/25/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Alan Sherman, DPM


 


In their responses to my comments on this topic, both Drs. Markinson and Jacobs insist on considering all podiatry students as a homogeneous group, but they are not. They are diverse in background, intelligence, interests, goals, and ambitions. I don’t accept the limitations that these two gentlemen feel that all podiatrists must accept. What if even 10-20% of senior podiatry students could pass an exam demonstrating medical knowledge in excess of what is being taught in the podiatry colleges? Shouldn’t they be allowed to test out and prove their advanced knowledge? After high school, most education is self-directed - not learned in classrooms but instead, sought out and learned by individuals. 


 


Some podiatry students have the capability to learn as much cardiology, neurology, dermatology as the average medical student. Some may learn more. My reference to the Frederick Douglas quote was not meant to focus on injustice, but instead on the concept that power and opportunity must be actively pursued as it is never simply voluntarily given. This has been the history of podiatry in the last 50 years, continually raising our standards to better serve the public. Let’s never become complacent and let’s continue to improve.


 


Alan Sherman, DPM, Boca Raton, FL

07/25/2022    

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



From:  Corinne Gehegan, DPM


 



Dr. Jacobs stated, “Our profession needs to strive to maintain excellence in the services which it provides.” I couldn’t agree more. In the past month, I have evaluated and managed a patient for a persistent ingrown 3rd digit toenail which was initially diagnosed and treated as gout by another podiatrist (the podiatrist happened to have completed a fellowship in “foot and ankle reconstruction”). I have also dispensed a size Small pneumatic CAM boot to a patient who was initially “fitted” by a podiatrist with a Medium which was entirely too large and posed a risk of falling. In the past month, I have also submitted a portion of a patient’s toenail to a lab to assess the presence of onychomycosis after another podiatrist “sold” the patient a Formula 3 kit without sending a specimen for analysis. The patient had been applying the topical daily for months without improvement. The PAS was negative. And podiatrists are concerned about parity!


 


I am also amused when podiatrists refer to themselves as “foot and ankle doctors”. Do Ob-Gyns refer to themselves as “vagina doctors”? Do dermatologists refer to themselves as “skin doctors”? Do dentists respond “tooth doctor” when asked what they do for a living? We are podiatrists. I am also intrigued when podiatry residents have accidentally been issued IDs indicating MD and continue to walk around with it for years. Would they have the mistake rectified if it said RN? We are podiatrists. If you don’t want to actually say that you are a podiatrist, or you are concerned about parity, USMLE, and scope, then ask yourself why you did not attend medical school to obtain the MD degree.


 


Corinne Gehegan, DPM, Edgewater, NJ


07/25/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Source For Local Anesthetics Without Epinephrine (Steven Block, DPM)


From: Ira Kraus, DPM


 


Talar Medical has a source for lidocaine and other injectables that have been affected by the national shortage. However, the source does not service the following states: Alabama, California, District of Columbia, Hawaii, Iowa, Indiana, Minnesota, North Dakota, Nebraska, Nevada, and Wyoming.  


 


Disclosure: I am president of Talar Medical.


 


Ira Kraus, DPM, White Fish, MT

07/22/2022    

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



From: James J DiResta, DPM, MPH


 


I read today comments by two of our most esteemed podiatrists Drs. Allen Jacobs and Bryan Markinson on podiatry's scope of practice. I'm certain they are very honest in their comments but their remarks are discouraging. These are two very bright and wonderful people. When you leave their lectures you always come away proud that you share the same cherished profession as them. They are smart. Allen can impress the best of us with his medical and surgical knowledge and insight. As a student at PCPM (TUSPM) in the '70s, I listened intently one day to a lecture he prepared on metal materials for surgical fixation procedures. When I returned home that evening, I didn't feel as smart as I did that morning and frankly if I needed a little more humility that day, he provided it. In my podiatry class at that time was another bright podiatrist to be, Charlie Arena.


 


Later, Charlie and I would be residents at Northlake Hospital, but before that time while we were doing externships, our paths crossed at a hospital in New Jersey. Charlie was on medicine that month and I was on the orthopedic service. By chance, I was walking in a hall outside a room where the externs on the medical service were meeting and the attending was belittling some of the medical students as he would ask them questions and when they couldn't answer correctly, he would then call on Charlie to answer. Charlie...


 


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

07/22/2022    

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



From: Ronald Sage, DPM


 



I couldn’t agree more with Dr. Jacobs’ full response to this issue. I struggled with my professional identity in podiatry school until I received advice from a role model I admired during one of my externships in 1976. Dr. Joseph Seiler achieved full podiatric surgical privileges at the local hospitals where he practiced at a time when that was the exception rather than the rule. His advice to me was, “you don’t succeed by trying to be something you’re not.” I followed that advice during my career at an academic health science center, and most would say I did okay.


 


Ronald Sage, DPM, Lake Geneva, WI


07/22/2022    

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



From: Randall Brower, DPM


 


Dr. Jacobs: You have been an amazing addition to the podiatry world. I hold you, my residency director, Charles Kissel, and others like you in high esteem for the selfless time and energy you have put into our profession. Your lived experience is your lived experience. I would not dare to call that into question. I would like to share with you, however, that my lived experience and that of others like me, are vastly different than yours.


 


I have been in practice for 18 years. I went to DMU, in Iowa. The first 2 years of basic science were the exact same as that of our DO colleagues. In fact, we were not separated except when they did OMM (skeletal manipulation), psych, and OB (3 classes). WE took the same tests in every subject, the same finals, and there were podiatrists who did take the DO board exams and...


 


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

07/21/2022    

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



From: Allen Jacobs, DPM


 



Dr. Sherman‘s quote of Frederick Douglass is hardly applicable to the “parity” discussion regarding podiatry and the MD and DO degree. Simply stated, it is disingenuous to suggest that the medical education of a podiatry practitioner is an any way equivalent to that of an MD or DO. It is not. Dr. Sherman knows this, PM News readers know this. A podiatrist is trained to be a limited licensed practitioner. That is reality.


 


This is not a matter of political power as Dr. Sherman suggests. This is a matter of public safety. It is part of a continuing illusion perpetuated by some in our profession. The training of a physician is more generalized and vigorous. Unlike Dr. Sherman, I have been continuously involved in podiatric education, and practice. I treat patients daily. I interact at the clinical level with...


 


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


07/21/2022    

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



From: Bryan C. Markinson, DPM


 


The USMLE or "equivalent" exam taken by podiatrists as discussed by Dr. Sherman will never materialize and if it does, who would take it and accept the limited scope of podiatry while others would have their choice of every medical specialty? Not enough to fill any podiatry school. 


 


The AMA and NBME say simply, just go to medical school. The quoting of Frederick Douglas' reference to "injustice and wrong" as a parallel to the AMA or NBME stance on podiatrists is a bit of a stretch and may be offensive, though I am  certain that none was intended.


 


Bryan C. Markinson, DPM, NY, NY

07/20/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Alan Sherman, DPM, Richard B Willner, DPM


  


In response to Dr. Orosz’s doubt that podiatrists taking the USMLE would do much to change the minds of AMA leadership concerned with “scope creep”, I suggest that the AMA would be even more concerned should we start passing the exam in large numbers and that’s exactly what we should seek to do if we can work out a way for our students to take the exam or an equivalent. Power is never ceded voluntarily, or in the words of Frederick Douglas, “Power concedes nothing without a demand. It never did and it never will. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them, and these will continue till they are resisted with either words or blows, or with both.” Our attitude should be that it’s not about what they want – it’s about what we deserve.


 


Alan Sherman, DPM, Boca Raton, FL


 


It is my understanding that "podiatry" ranks low on the AMA "hit list". Podiatry is a very small profession, and it just does not have the "annoyance factor" that the NPs, PAs, and optometrists "enjoy". Sorry, podiatrists are just not that politically important.


 


Richard B Willner, DPM, New Orleans, LA

07/19/2022    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: AMA and Podiatry’s Scope of Practice


From: Michael Orosz, DPM


 


More food for thought regarding the DPM vs. MD debate. In this article, AMA is bragging about their efforts to stop what they call “scope creep”, which includes a bill expanding podiatrist scope of practice in Alabama and a Maryland bill that would allow podiatrists to use the term podiatric physician. Somehow, I doubt podiatry students taking USMLE exams will do much to change their minds.


 


Michael Orosz, DPM, Cedar Rapids, IA

07/12/2022    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Name Withheld


 


At an extended care facility, an MD asked for my opinion for a newly-admitted resident with a severely infected foot and cellulitis extending proximally to the malleoli. 


 














Cellulitis



 



I charted, “Take resident to hospital emergency ASAP, STAT!” This would involve 1-2 staff members to escort the resident to the hospital. Rather than have the resident transported to E.R., the MD Rx’d 2 different oral antibiotics. Unfortunately. my advice was not followed. After 2 weeks, as the infection continued to spread, palliative care was provided. The resident passed away within 6 weeks. 


 


Name Withheld

07/12/2022    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Insurance Companies and e-Prescribing 


From: Jeffrey Kass, DPM


 


I sent in an Rx for clotrimazole and ciclopirox solution for tinea pedis and onychomycosis respectively. I got a call from the pharmacy telling me those two were not covered by the patient’s insurance and the patient asked they be substituted. I asked the pharmacist if they could give me a clue as to what is covered. They replied, “I am sorry, I cannot. You just have to keep sending.” How stupid is that? 


 


With all the sophistication of technology and computers, is this where we are? I pay an EMR and have E-prescribing capabilities, but the computer (or possibly I) doesn't know the insurance formularies. If I am correct in what I am saying, this is ridiculous. Shouldn’t insurance companies have to play their role in EMR technology and integrate patient formularies with EMRs the same way doctors are forced to comply with MIPS and MACRA crap? 


 


Jeffrey Kass, DPM, Forest Hills, NY

07/08/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Ben Pearl, DPM, Steven Finer, DPM


 


Depending on his ability to derail your committee position, I might have responded to the snappy bow-tied neurologist in my best Irish brogue (A la Dr. McCoy) “For God’s sake man, I’m a doctor, not a mechanic!” 


 


Ben Pearl, DPM, Arlington, VA


 


It was the good old days of 1976. I was rotating through the local VA with a group of medical students. We had grand rounds with an eminent surgeon. Question of the day: venous ulcerations. The med students sat there staring into space. I pop up my hand and proceed to answer. As I finish, the professor asks, “Who are you?” I am Steve, the podiatry student. His eyebrows cross and he says, “You will have to leave." Fast forward 4 years. l had surgical privileges at 2 local hospitals. I shared an office with a plastic surgeon. 


 


Steven Finer, DPM, Philadelphia, PA
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