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09/30/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Timothy Ford, DPM
I would like to address the ongoing issues of CAQ and the Boards and make some salient points to clarify many of the statements made. These are my personal opinions and what I have observed in an academic setting as well as being a residency and fellowship director:
• Board certification demonstrates minimal competency; it does not demonstrate the fact that someone excels in any form of surgery or medicine. In fact, Board Certification tests Minimal Competency as the definition below states:...
Editor's note: Dr. Ford's extended-length letter can be read here.
Other messages in this thread:
02/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Gregory T. Amarantos, DPM
Being recently retired, I am volunteering alongside Dr. Roth. For the past few weeks, I have read the posts and I believe the issue is multi-faceted. Forever the cynic, I follow the money. Where to start? Too many schools with too few candidates, thus the schools admit less qualified applicants, in turn, less qualified physicians and surgeons. Hospitals want the residency programs because they are a cash cow. All the different boards want your money so you can show you are board certified and capable of doing surgery. We all know colleagues who should never hold anything but a #10 blade to do C&C. Then let’s get to the APMA which for the past decade has shoved diabetic foot care and wound care down our throats as if that is all we are capable of doing. Follow the money; the wound care companies co-sponsor meetings.
Of course, the practicing podiatrists themselves have contributed to the lack of awareness of our profession as "everyone" qualifies for Medicare coverage. Why are so many afraid to tell the patients the truth... you do not qualify for this service and the fee is...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Oloff, DPM
Why are applications down? Everyone who has weighed in on this is correct: too many schools, lack of identity, competition, costs, etc. Everyone who has suggested solutions is also correct: profession, schools, practitioners all need to reach out more for effective recruitment. The problems and solutions are multifactorial. How do you fix this? I don’t think you can close schools, however economics will eventually solve this problem. I do not think that all the schools will survive economic downturns forever.
I was talking to a businessman recently about this. His perspective was not what I expected. He began to cite the supply and demand curve. He thought if the supply of podiatrists went down and the demand was the same or greater, then the salaries of podiatrists would likely go...
Editor's note: Dr. Oloff's extended-length letter can be read here.
02/06/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Allen M. Jacobs, DPM
Recruitment? It is indeed a sad day that our colleges have been compelled to develop strategies to enhance student recruitment efforts. It is depressing to hear a call for practitioners to make efforts to recruit students. PM News readers have expressed an eclectic universe of explanations proposing the etiology for the lack of interest in our profession. Many if not most of these explanations are reasonable, and perhaps the sum total of all of these propositions explains the current disinterest in podiatry among college undergraduates. Facts are what they are. There is a demonstratable lack of interest in pursuing a DPM degree. The numbers speak for themselves.
There is no issue that the services provided by a podiatrist are needed. The issue is whether a podiatrist is needed to provide those services. As other PM News contributors have noted, services provided by a podiatrist may be provided by orthopedic surgeons, general surgeons,...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/05/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Chuck Langman, DPM
My take as someone who is closer to retirement than just starting out is a little nuanced as we can only see life through our own eyes. I did a one-year surgical residency in the 1980s. I came out being comfortable and proficient with forefoot surgery. As I did more surgery, I realized I wasn’t in love with it (and you need to be in love with it to be great at it). I kept only to the procedures I was comfortable with and never ventured out of my comfort zone. I enjoyed far more the people I was able to keep out of the OR and the athletes I treated conservatively. Fast forward to when I was about 50 years old and was lucky enough to join a very large orthopedic group that allowed me to be non-surgical and do orthopedics and sports medicine all day.
I truly love what I do! I have a team of surgical podiatrists and fellowship-trained foot and ankle surgeons to refer to for the cases that need surgery. I also note that we have a large team of...
Editor's note: Dr. Langman's extended-length letter can be read here.
01/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Aaron Solomon, DPM
Do pre-medical students know that podiatric medical school is an option? This is an important question to ask when addressing the low enrollment to podiatric medical schools. There was little information given to our pre-med guidance counselors about podiatry school. I was able to get more information from the schools by contacting them directly.
We had faculty from medical and dental schools talk to our pre-medical majors. I wonder if there is any similar outreach on a national level either from APMA or ACFAS to have the opportunity to visit with pre-medical majors and speak to them about the opportunities in the podiatric profession.
I would also look at the schools of podiatric medicine to see if they are continuing to provide an education and curriculum that is commensurate to an allopathic...
Editor's note: Dr. Solomon's extended-length letter can be read here.
01/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Elliot Udell, DPM
Dr. Roth, once again asks why we as podiatrists cannot be trained to do procedures such as spinal stimulators and stents to treat PVD.
There is no doubt that Dr. Roth and most DPMs are smart enough, with proper training, to do these procedures and do them well. It all boils down to legality. Dr. Roth states that he spoke with legal counsel who said, "If the law says we can do it, why not?" The obvious question is what the law in each locality will and will not allow concerning surgical procedures done way above the ankle which directly affect the treatment of pathology in our anatomic scope of practice.
In essence, our ability to perform these procedures will probably be decided by state legislatures and courts, and we should not expect state medical societies to stand by idly and watch us take these procedures from their members.
Elliot Udell, DPM, Hicksville, NY
11/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Brian Kiel, DPM
I am confused. None of the treatments supposedly offered and/or performed by the “insurance“ podiatrist are unethical. I have used each of those treatments in the 50 years that I’ve been in practice, maybe not in the order, but offered and used, and when one treatment plan was unsuccessful, we would try another.
I’m also confused by Dr. Roth’s dismissal of the financial aspects of any one or all of these treatments. Does Dr. Roth not charge for any treatment he does and expect payment from the patient since he does not participate in any insurance plans. It seems to me that Dr. Roth’s anger is based on the fact that the patient went to another doctor. I find it helpful in treating a patient to know what was not successful when treated by another doctor. As others have said, none of us are 100% successful in treating any problem.
Brian Kiel, DPM, Memphis, TN
10/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Paul Kesselman, DPM
I must admit that those promoting this are either a mentor and friend of the last twenty years (Doran Edwards, MD) or Lawrence Rubin, DPM, a longtime mentor, friend and former teacher of mine at ICPM in the late '70s and '80s. So it pains me to have to offer some criticism of each of their posts. And I will have attempted to speak with or have already spoken with both of them prior to this post being printed.
For one, Dr. Edwards and I have worked together numerous times to improve the therapeutic shoe bill, met with DME MAC medical directors and CMS to improve the accessibility to beneficiaries by removing some of the...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
In a recent post, Dr. Freireich said, "If APMA promotes an Annual Comprehensive Diabetes Prevention Foot Examination, I hope they also promote that the exam is not covered by insurance, unless things have changed since this issue was also brought up."
Actually, there has been some progress in gaining covered podiatric Medicare diabetes amputation prevention examination coverage. Although we have not yet succeeded in gaining coverage for a comprehensive diabetic foot examination (CDFE) to screen for many potentially hazardous lower extremity problems, podiatrists can now be well reimbursed when providing...
Editor's note: Dr. Rubin's extended-length letter can be read here.
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
Along with others in this thread, I am also an APMA Life Member who has no vote and is grateful to Barry Block for giving us an invaluable platform to voice our opinions. Relevant to this thread, back in 2012, I was very active in several APMA activities and worked together with other podiatrists throughout the nation and APMA assigned program personnel in providing the, "Knock Your Socks Off" public information campaign. APMA launched this public service program to educate the public about amputation prevention and other foot healthcare matters, to create awareness of the broad scope of our podiatric practices, and to show the public that we are the preferred providers of footcare.
Although the program was magnificent in structure and content, it depended upon APMA members in all states and communities working closely together in conforming to a program implementation plan. I was assigned the State of Nevada, and was pleased to report that the program did raise community awareness wherever the local volunteer DPMs were willing to participate in the program. Unfortunately, too few podiatrists nationwide were willing to get involved personally or assign their staff members to provide the program elements. For this reason, the program had to be discontinued.
When the Knock Your Socks Off Program was discontinued, I and a small group of Las Vegas APMA members who were providing the APMA Knock Your Socks Off program elements joined together in 2010 in order to help to create the non-profit Lower Extremity Amputation Prevention (LEAP) Alliance. LEAP creates community-based lower extremity amputation prevention programs in collaboration with local healthcare and community services entities.
Lawrence Rubin, DPM, Las Vegas, NV
08/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Ira Cohen, DPM
I join Rod, Larry, and Name Withheld in deciding not to pay the voluntary contribution after 39 years of practice and 4 years of Life Membership. I learned so much from senior DPMs like Sy Lane, Howard Marshall, and a long list of veteran podiatrists. As California podiatrists, we fought for years to obtain ankle privileges (I believe 2nd in the nation) establishing a path for many states to follow. For APMA to take our contribution and not allow us to vote indicates they have no regard for our decades of experience in medicine and politics. Ira Cohen, DPM, Boca Raton, FL
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
I am an APMA Life Member. I love APMA and its decisions most of the time, but not always. Not only can we not vote, but in the past, I have found that suggestions for specific positive actions that would benefit podiatry and our contribution to public health have been disregarded without explanation. One would think that new ideas and opportunities would be welcomed and respected and not treated with indifference. Lawrence Rubin, DPM, Las Vegas, NV
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Robert Boudreau, DPM
When I entered private practice in 1984, I wanted to apply at one of our local hospitals for surgery privileges. I called and made an appointment with the chief of staff, a gruff old cardiothoracic surgeon. When I showed up, rather than meet in his office, he chose to hold our meeting in the cafeteria. After going over my credentials and residency training, he said, “I’m sure we can grant you privileges. I often have patients that need a good toenail trimming.” I tossed the application in the hospitals round file cabinet. Fast forward to the late ‘80s, early ‘90s when PPOs and HMOs hit the scene. The hospital came begging for podiatrists to come to their ORs and do outpatient surgery. I applied for privileges and was granted every privilege I asked for. As my practice grew, I had less time to travel to that facility (a 30 minute drive from my office), and since I held privileges with 2 hospitals within a 5 minute walk from my office, I made the decision to give up the privileges at the distant hospital. I wrote a letter stating my intentions to the grumpy... Editor's note: Dr. Boudreau's extended-length letter can be read here.
12/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Rod Tomczak, DPM, MD, EdD
For most of the 1970s, I was either a podiatry student in Ohio or a resident in Philadelphia. There was a television advertisement for a financial company called E.F. Hutton where a broker spoke to a client who was sitting next to him in a filled Yankee Stadium. As the broker talked investments to his client, the stadium suddenly went silent and the narrator simply said, “When E.F. Hutton talks, people listen.” The information the broker was giving his client was so important it could silence Yankee Stadium. The concept was an admitted hyperbole, but clever, nonetheless.
I was lucky enough to have had both Allen Jacobs, one of my trainers, and Jim Ganley speak to me, and I listened. Both educators spoke to the “why” of facts being transferred from teacher to students in such a way that the “why” could be answered at least three times. Parents know the frustration of trying to answer a child’s...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/08/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Allen Jacobs, DPM
I would like to explain my position with regard to the screening of patients for “at-risk” clinical circumstances necessitating lower extremity amputation prevention podiatric care. LOPS typically means a 10 gram filament test. What about loss of vibratory sensation with intact monofilament testing? What about loss of temperature perception with intact light touch? What about motor neuropathy with intrinsic minus foot and evolving deformities? What about peripheral autonomic neuropathy, in some respects, the most important aspect of neuropathy due to its association with cardiac disease?
What about entrapment neuropathies which occur with increased frequency in patients with diabetes? Screening testing and stratification for risk is only as good as the testing which is done. Effective screening results in an effective effort to reduce amputation risk in our patients with diabetes. Effective screening requires time and effort, and needs to be reimbursed accordingly.
Allen Jacobs, DPM, St. Louis, MO
08/04/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Elliot Udell, DPM
Drs. Jacobs and Guiliana and both correct. There needs to be comprehensive podiatric evaluation of diabetic patients that can be performed annually and will be covered by all insurance companies. The problem is consensus on what constitutes a pedal diabetic foot examination. Several years ago, at a board meeting of the American Society of Podiatric Medicine, we tried to establish such an examination that would be accepted by all podiatrists and the insurance world.
To our chagrin, each of the board members who were involved in some aspect of podiatric academia, including one who was also dean of a medical college, all had different ideas as to what a comprehensive podiatric diabetic foot exam should consist of. Each doctor was firm that his protocol was the only correct one, and there was no consensus. There was no room for compromise. We dropped the project.
Perhaps Drs. Guiliana and Jacobs who have wide support from all aspects of our profession could get the ball rolling again and could help establish consensus for a comprehensive podiatric diabetic foot exam that will be accepted by all podiatrists as well as all insurance carriers. It may seem like a high mountain to climb but if this is successful, it could save the limbs and lives of many of our patients.
Elliot Udell, DPM, Hicksville, NY
07/13/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
I want to thank Dr. Ressler for his, “Killing the Chicken Who Lays the Golden Eggs” story. He witnessed the flagrant abuse and outright fraud in the early 1980s that occurred when all too many podiatrists abused the billing of CPT code 11730 - nail avulsion.
It is so sad that even now, because of this long ago situation, it is no longer a question of whether or not a podiatrist will be subjected to a random or targeted audit of 11730 coding and billing. It is more a question of when this audit will occur. But this is not the end of the Golden Egg story. Things got worse.
In the early 1980s, the abuse...
Editor's note: Dr. Rubin's extended-length letter can be read here.
07/05/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Robert Kornfeld, DPM
May I say one thing on the subject of change - Knowledge is knowing that a tomato is a fruit and not a vegetable. Wisdom is knowing not to put it in a fruit salad. In my opinion, insurance-dependency is like putting too many tomatoes in your fruit salad and allowing it to overwhelm the sweetness that you could otherwise enjoy.
Dr. Udell, many podiatrists all over the country have already included therapies into their practice that are not covered by insurance. They also sell products. That approach is called a hybrid practice. The difference is that these docs depend on services that are covered by insurance and then privately contract with patients for direct payment for ...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
06/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Ric Boggs
Full disclosure, I am the President of Gill Podiatry Supply and Equipment Company. There are several good vendors out there for x-ray equipment. Most companies sell one product that they, of course, will say is the best. We sell multiple systems from multiple manufacturers. When considering x-ray solutions, there are really three products. 1. The x-ray machine that generates the x-ray. 2. The panel or system that develops the x-ray. 3. The software that processes and enables you to view and store the image. Every practice is different with various levels of technology, needs, desires, and capabilities. When you try to integrate a new system into your practice, there are many things to consider. Ric Boggs, President, Gill Podiatry Supply & Equipment Company
05/23/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lee C. Rogers, DPM
I respect Dr. Tomczak’s defense of Dr. Carnett’s expertise, but I wish to correct a couple of misunderstandings. Firstly, the “ABPM International” is a legally-separate entity from ABPM, with a separate BOD, which certifies podiatrists who were educated and trained outside the United States and tests according to that standard. Dr. Carnett was educated and trained in the U.S. and would be subject to a U.S.-based board, especially if he wishes to return to practice in the U.S. There is regrettably no pathway for a podiatrist who completed a one-year training program in the 1980s to now become board certified by either of the CPME-recognized boards. Secondly, in order to be eligible for the ABPM’s CAQ in Podiatric Surgery, a podiatrist must have completed a surgical residency, in addition to other requirements. I’m happy to discuss this further with either Dr. Tomczak or Dr. Carnett. Lee C. Rogers, DPM, President, ABPM
05/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Multiple Respondents
Congrats to Dr. Block! 7,500 issues and 29 years is truly remarkable. I’m not sure if Barry himself is in the “Podiatric Hall of Fame” but if he isn’t already, it’s about time. PM News has succeeded in becoming an integral part of podiatry on a daily basis and at the end of the day, that’s pretty cool. Wishing Dr. Block continued success. Jeffrey Kass, DPM Congratulations on the wonderful PM News milestone. Thank you for making this newsletter happen! Judy Sperling, DPM Congratulations on the “Millennium Jubilee” issue milestone! PM News has helped the podiatry community stay connected. Ben Pearl, DPM Barry: Congratulations for all your personal time, family times and their support, and the podiatry profession for being a very important part of this great profession. Your health needs to be strong for more accomplishments. Best personal regards for this wonderful publication. Steven J Berlin, DPM Editor's note: We thank all the well wishers who took the time to write or call us.
05/19/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Matthew G. Garoufalis, DPM
In response to Dr. Carnett and his concerns about not being unable to take the American Board of Podiatric Medicine International exam, I would like to explain that this exam is only directed to non-US trained podiatrists that meet a certain criteria in their level of education. We all are aware that medical providers around the world are all trained differently, but are still able to provide patient care effectively. This rigorous exam is aimed at those podiatrists who seek board certification beyond the mandatory regulatory standards in their area of practice. It is not designed for, or intended for, U.S. trained DPMs who are asked to follow CPME guidelines for board certification. This exam is designed to raise the bar for podiatry, outside the US, for those podiatrists who have trained in countries that meet a designated educational requirement. Currently, that is at least a 3-year baccalaureate degree in podiatry. This should not in any way be compared to the U.S. education model because the U.S. model is different from that of the rest of the world. As a result, we now have a different and rigorous exam for those trained to the high standards needed to sit for this exam. Please take a look at the ABPMi website for more information. Matthew G. Garoufalis, DPM, Chicago, IL
03/24/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Rich Hofacker, DPM
In the late 1980s, I became board eligible. However, I never had quite enough cases to sit for certification. I was very fortunate to be grandfathered into my area hospitals to enable me to practice what I was trained to do. When I had the appropriate number of cases, I was told by (at that time) ABPS, that I could no longer sit for the certification examination, which never made sense to me.
Now we have a battle between ABFAS (the old ABPS) and ABPM, which has divided our profession and made us a laughing stock in the medical world. No one wins in litigation. What is needed is negotiation, but both sides have to be willing to come to the table and negotiate in good faith. We need to have one board that can be...
Editor's note: Dr. Hofacker's extended-length letter can be read here.
01/27/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Randy Anderson, DPM
Actually, the avoidance of protectionism and allowing increased access to privileges are the reasons behind the requirement/opportunity for the applicant to show that an alternate certifying body is equivalent to the accepted certifying body.
Given your experience on a credential committee, I am sure you are aware there are certifying bodies for a multitude of activities beyond surgical specialties. For each of these, there was an initial organization that developed specific standards that had to be met in order to achieve certification, and generally speaking that initial body is the...
Editor's note: Dr. Anderson's extended-length letter can be read here.
11/25/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Elliot Udell, DPM
Thank you Dr. Oloff for shining a light on the commercialization of medicine. The example given was just the tip of the iceberg. Look at the commercials being advertised on television all day long. They advertise drugs for breast cancer, psoriasis, injections to control cholesterol, diabetes, etc. Some of these drugs may be very helpful, but many of them have side-effect profiles and only the patients' oncologist, rheumatologist, endocrinologist or dermatologist can determine if it is a right choice for a specific patient.
I have a personal ax to grind. I am a breast cancer patient and there is one drug advertised all day long. They depict the people taking it as happy, family people going about normal lives with their children and grandchildren. I took the medication for three days and was ready to call 911 and the side-effects I endured were not rare but common to all who take the drug. In the original studies, a large percentage of people had to drop out because they could not tolerate the side-effects.
Elliot Udell, DPM, Hicksville, NY
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