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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:
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
10/03/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Martin M Pressman, DPM
I have been involved at all levels of training in podiatry. Starting with full-time teaching at TUSPM, residency training for 47 years, committee work for ABFAS on all examination levels. I was part of the team that developed CBPS, and remain on the Case Review Committee for my final year. I was also chairman of my state board in Connecticut for 40 years. I am part of the residency training program at Yale and was Section chief of podiatry in the department of orthopedics, at Yale School of Medicine 1997-2017 until we became a department at Yale New Haven Hospital with a full time department chair. I say all this to allow you to understand my perspective on this critical issue in podiatry.
I have read Drs. Oloff, Jacobs (both friends) and Dr. Ford (well respected) on this issue and all make salient points. I would like to add to the discussion with some other critical observations. #1. It is the licensing examination that sets the “minimal competency level...
Editor's note: Dr. Pressman's extended-length letter can be read here.
09/09/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Stephen Peslar, BSc, DCh
I saw the commercials for a Good Feet Store in Buffalo on TV from a Buffalo-based broadcaster. The commercial also has a disclaimer for their pre-fab inserts. The commercials are so glossy that I want to visit the store in Buffalo to see the set up. I live in Toronto, Ontario, Canada and have to show my passport to cross the border. One weekend, in October, we’ll shuffle off to Buffalo for a weekend stay and I’ll visit that store.
One of the sales strategies they may use is “the OTC orthotics are satisfaction guaranteed or money refunded.” An unhappy customer returns them and gets $800 back because the $200 is for the cost of fitting and dispensing the orthotics because they are medical devices and can’t be sold to anyone else. Of course, the pre-fabs are about $30 so they still make money, even when money is “cheerfully” refunded.
Stephen Peslar, BSc, DCh, Toronto, Ontario, Canada
09/07/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Jack Sasiene, DPM
Yes, Dr. Ressler, I have patients who come in routinely….one every few months…who have paid $1,200 or more, for a set of pre-fab devices from the ‘Good Feet Store”. They sell a “set of increasingly corrective devices” where the patient starts with the first and progresses to the last. It is very frustrating to see an “inexpensive” device sold for such an exorbitant price.
However, once proper biomechanics are explained and how a true custom device is cast (yes with plaster, don’t get me started on scanning!)….they are willing to pay a more reasonable, lower price and get relief of their issue.
Jack Sasiene, DPM, Texas City, TX
08/18/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Timothy Ford, DPM
My colleague and friend Dr. Jacobs is spot-on regarding podiatric medicine and surgery residency (PMSR) training. Having the opportunity to evaluate many programs in the past 20 years, I can tell you there is a vast difference between programs. Although CPME 320/330 provides common requirements, institutionally and program-wise, there is a clear difference in residency training across the country. This is particularly true when it comes to academic medical centers and community hospitals, not just in training but in overall institutional monitoring of residency programs.
Academic institutions often have 100+ residency and fellowship programs they oversee, whereas community hospitals may have only a PMSR at their facility. A critical component of medical education involves interaction with other residents and fellows in various specialties which enables valuable interdisciplinary learning to be...
Editor's note: Dr. Ford's extended-length letter can be read here.
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
06/06/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Robert Scott Steinberg, DPM
As random and prevalent mass murder is occurring, due to the unfettered access to guns, I don't feel safe, anywhere. Seeing what happened in Oklahoma, the gunman was just a few days post-op. He went out and bought an AR-15 and used it two hours later. How do you predict that?
Today, I was supposed to be at the Rotary International Convention in Houston. After the two murderous rampages, that killed 21 people, I canceled. No, I do not feel safe.
Robert Scott Steinberg, DPM, Schaumburg, IL
06/25/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
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
06/09/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
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
03/10/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
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
02/12/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: John Moglia, DPM
I'm one of the silent majority content with my limited license but not content with the disparity in reimbursements, if they exist. My kid brother, a critical care surgeon, retired at 64 burnt out by the demands of his specialty and his low reimbursements. Years ago, when reimbursements were reasonable, whenever I would complain to him about the lack of acknowledgement and licensure limitations of my DPM degree, he would say just "laugh all the way to the bank."
However, I'm no longer laughing as reimbursements continue to decline. While legislation without proper training is not the answer for parity in scope for those who seek it, it might be more appropriate for approaching the insurance industry by our representatives. Who can we turn to for a realistic plan for the future? Can anyone reveal the actual disparity in reimbursements comparing DPM vs. MD?
John Moglia, DPM, Berkeley Hts, NJ
02/08/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Paul Betschart, DPM
Aside from a few orthopedic foot and ankle surgeons (who we have some turf overlap with), I have never felt a lack of respect or parity from any of the MD or DO physicians that I have interacted with over the course of 30 years of practice. Disparity with payments makes little sense as our overhead expenses are the same as that of other doctors. I consider myself a podiatrist with foot and ankle surgery as a subspecialty so to speak. I believe the more podiatry residents train in hospitals with other MD and DO physicians, the more respect our profession will get in the future. I leave it to our associations to battle the payors for parity on that level. We should all support these efforts with our associations as there is strength in numbers.
Paul Betschart, DPM, Danbury, CT
02/05/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Sheldon Miller, DPM
Parity. Who cares about parity? I practice with a brilliant board-certified neurologist. Over the past 5 years, he has been increasingly treated like garbage from the insurance companies, Ciox, etc. His reimbursements have gone down just like ours. If the public doesn't care about a life-saving doctor, they will never care about our profession (podiatry, specialty). I don't care what you want to call us, but we have to hold our own by ourselves. Getting paid with INCREASES annually shows respect. Pay me what I deserve and you can call me whatever you want to.
Sheldon Miller, DPM, Rockaway Park, NY
02/04/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Randall Brower, DPM
I have to push back a bit regarding the whole parity argument. This argument is frankly old and tired. We are podiatrists. I did a 3-year residency in Detroit at DMC from 2001-2004. Yes, the first year, we did a 4-8 week course of internal medicine, ICU, ER, trauma, general, vascular and plastic surgery rotations. Yes, we have a very small overview knowledge of these general medicine and surgical specialties. But, Dr. Cox, what do you want to do with a parity degree?
We are both somewhere between 15-20 years in practice. Medications, disease management, and surgical approaches have changed significantly in the past 2 decades for all specialties. I think you might be overstating that you, or I, have vastly more knowledge in medical treatment of...
Editor's note: Dr. Brower's extended-length letter can be read here.
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