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From: Edwin S. Hart, III, DPM


Sadly, those who do not know history in medicine and surgery are doomed to repeat it. The gray hair represents, most of the time, a historical frame work reference in matters. Often, I see a lack of interest in that perspective in training of students. They do not realize what they might be missing. So some of these ideas will be lost until a future generation rediscovers them. As my wise father said, "don't get rid of your narrow ties, they eventually come back in style." Just like MIS, I guess.


Edwin S. Hart, III, DPM, Bethlehem, PA

Other messages in this thread:



From: Jack Ressler, DPM


I was recently introduced to ChatGPT by a friend of mine. It is one of the new online search engines that uses AI (artificial intelligence) to provide some amazing results. I have spoken to some people in the investment field and they say ChatGPT is actually making Google nervous! And one of the people behind this company is none other than Elon Musk. What a surprise.


Jack Ressler, DPM, Delray Beach, FL



From: Steven Selby Blanken, DPM


I disagree with a recent opinion from a respected DPM who has been retired for many years. Things are way different now with the increases in costs to run a practice, as well as the improvements we can use to remind patients about their visits. Yes, most successful practitioners do charge for no shows, especially without notice. It doesn’t take much to send a reply when you get a reminder call, email, and even a text message (let alone, the appointment card given to patients as they leave a visit). Interesting, most will find that most “no shows are from Medicaid patients. On a separate note, most of us who treat people with mental disabilities have a power of attorney/or responsible family member, or even a paid caregiver who has been designated to be responsible for the next appointment. Of course, if they were sick or” if something bad happened, yes, we waive the fee for that person.


We also have a 3 strikes rule and you are out. We also increase our charge if you have missed more than one visit. It is hard to practice when you average 3-6 no shows a clinic day. Costs are rising and insurance companies are rejecting more and more reasonable modifier -59 charges that you have to appeal, win, then appeal again when you see the patient again. So, I am sorry but this is the world now. You need to charge for these “no shows” to stay afloat.


Steven Selby Blanken, DPM, Silver Spring, MD



From: Robert Scott Steinberg, DPM


Mr. Schwartz, You are incorrect. The DPMs I know always discuss shoes. I do know non-DPMs not only do not discuss shoes, but they also give their clients their orthotics in a plastic bag and tell them to put them in their shoes.  


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Brent Beirdneau, DPM


I have read many of the responses to ABPM’s recent plans for a CAQ in surgery and many are unbelievably frustrating. The current process ABFAS has for certification seems unnecessarily drawn out, expensive, and tedious. I know most of my colleagues feel the same way. If we are truly concerned about patient safety, as many of the responses seem to indicate, why are we not ensuring that recent residency graduates are “up to snuff” before letting them perform surgery unsupervised for 6-7 years? 


Why am I allowed to perform ankle surgery for 6 years without supervision, building my surgical skills and techniques along the way with that experience, and then at the end of that period if I don’t submit the right cases or want to pay more fees, I am all of a sudden deemed no longer qualified or unworthy to do more surgery? How does that make sense? Either our training received in school and residency is sufficient or it is not. Either a surgeon feels comfortable to do a surgery or they don’t (and if they don’t then they shouldn’t do that surgery regardless of the training they have received). We should have whatever necessary testing done at the time of residency graduation and not continue the charade for years on end. I applaud ABPM’s effort to provide a simpler and more streamlined process for achieving surgical “worthiness”. Please continue your efforts ABPM!


Brent Beirdneau, DPM, Salem, OR



From: Steven Spinner, DPM


The continued arrogance and persistence of Lee Rogers in his passing himself off as the savior of our profession continues to amaze. The recent AACPM statement "seemingly opposing" his CAQ in surgery just mirrors the sentiment of every other major stakeholder in our profession. His continued full-frontal attack on ABFAS as having "an abysmal pass rate for a board which holds itself out to be the gatekeeper to operating rooms across the country" is at the very least untrue on both accounts, and at its worst is unethical and unprofessional.  


Someone needs to remind Dr. Rogers of what the true mission of board certification actually is...the protection of the public. It is not to increase recognition for the podiatrist to increase personal gain. It is also counterproductive to offer a CAQ in surgery by a medicine board...a move that would be immediately sanctioned by our allopathic colleagues. The patient will not recognize the difference between true certification in surgery and a CAQ in surgery. 


This confusion will only continue to be unfair to the patient seeking a surgeon who actually has demonstrated his or her competence through a rigorous certification process. A process that actually evaluates competence in the performance of surgery. It will also be detrimental to our standing in the medical community when it is realized that our profession has sanctioned, by our inactivity, this bogus CAQ.


Steven Spinner, DPM, Plantation, FL



From: Dan Michaels, DPM


I'd like to thank Dr. Stewart for his video on expensive OTC orthotics. I know him and agree with Dr. Blanken in his opinion of Dr. Stewart. Dr. Stewart is a straight shooter, and very giving of his time and energy to the profession in our state. He was simply trying to highlight the outrageous price people are paying after they get conned into buying useless OTC orthotic devices. It is shocking that this is occurring, which is the point in your reply, that I can agree with, Dr. Ressler. You can see just that expression from Dr. Stewart in his video that he offered to anyone to use for free. Thanks again for providing this video for us and highlighting this issue.  


Dan Michaels, DPM, Frederick/Hagerstown, MD



From: Steven Finer, DPM, Bret Ribotsky, DPM


Good Feet orthotics have been sold on cruise ships for a number of years. They are pieces of plastic sold in threes as they “correct your arches.” They have a customer stand and they pull the person forward, then do it with the device in place and there is no movement. Usually the audience is amazed. The usual price is $1,000. I pointed out to one of the sales people that you could perform that trick with a stale piece of rye bread under a heel. 


Steven Finer, DPM, Philadelphia, PA


What we learned from this incredible back-and-forth discussion is that people are willing to pay over $1,000 for orthotics. This begs the question why don’t those in this profession collectively charge at least that price. A few years ago, one of my children was living in Manhattan and needed a pair of orthotics. I sent them to a well-respected DPM  for those devices. He offered me a 50% discount and it only cost me $1,000; therefore, his normal price was $2,000 for a pair of orthotics.  


Maybe this is a wake-up call that we should all be hearing - if OTC devices are going for over $1,000, then custom devices should go for quite a bit more. Has the market spoken?


Bret Ribotsky, DPM, Fort Lauderdale, FL



From: Timothy Ford, DPM


Thank you, Tim Ford, DPM, for the most sensible response yet to the ABPM CAQ in the podiatric surgery issue and the most balanced and useful opinion on the entire podiatric training issue. Of course, not all podiatric residency programs are equal…there is considerable diversity among them. Of course, a CAQ is only a CAQ and is not board certification. Of course, we ultimately need to consolidate our surgery and medical boards into one board certification in podiatry. 


I would add that CAQs by ABPM would recognize additional competence in surgery, wound care, sports medicine, etc. Our board certification process needs to recognize what all competent podiatrists have in common, but also that there is diversity among us and that some of us have additional competencies that deserve to be recognized. This evolution will make us stronger as a profession and be less confusing to the medical establishment. We need to evolve to be more easily understood.


Alan Sherman, DPM, Boca Raton, FL




From: Allen Jacobs, DPM


The ABPM surgical CAQ question is emblematic, not unique, to the “surgical certification” issue in podiatry. For many years, this profession has offered alternatives to ABPS now ABFAS for “certification” in foot and ankle surgery. Whether such alternative "certifications" have been accepted for credentialing at the local level is another matter. Additionally, our profession has accepted 2 levels of “recognized” certification, foot and rear foot ankle. Therefore, the concept of “party qualifying” a podiatrist for surgical privileging is neither a unique nor recent concept.


The issue is to what extent should an ABPM member be trusted to provide surgical services, and who should determine the extent of those privileges. A gastroenterologist may perform an endoscopic examination but not a bowel resection. A general dentist may perform extractions or uncomplicated root canals but not a...


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



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



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.



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



From: Dieter Fellner, DPM


I recently had cause to delve into and discuss the topic of practice evaluation. A business broker, with decades of experience, shared with me his opinion of practice valuation: "they are junk, I stopped doing them years ago, waste of paper and money." Adding that most buyers need to apply for finances, it is the underwriter who will determine if the banks' criteria can be met. 


He opined also that many deals fail when a seller has unrealistic financial expectations or is too emotionally invested. Discussed further, the underwriter explains, "there are a lot of moving parts when considering a loan application."  The practice valuation is not one of those parts.


In the final analysis, a good deal is one that both parties are satisfied with. And the bank agrees to make a loan based on their own business analysis. A seller may want to showboat their most profitable year of the business. Some sellers seem to have developed 'COVID denial' and do not consider the impact this has had on business, in the last two years, often preferring to quote 'pre-covid profits'. He adds that most deals can find a solution when the business is realistically priced. How much is a business worth? 30%-50% of the gross annual income will be typical in many successful negotiations. 


Dieter Fellner, DPM, NY, NY



From: Alan Bass, DPM


One of the things that I talk to my patients about more than anything else is expectations. I always talk with them about using a topical medication, and the one that I use exclusively is Tolcylen. Over the years, I have gotten good results. With co-pays and co-insurance as high as they are nowadays, patients may not be willing to pay high amounts for prescription topicals. I have found the efficacy of Tolcylen along with using a topical antifungal powder works well.


Additionally, from a business perspective, having something readily available for dispensing is something the patients want. I have now incorporated the use of Tolcylen powder/foot soaks into my regimen, also to treat the foot environment. When appropriate, I also talk with patients about treating from “the inside out and the outside in”, and if the patient is a candidate, or is willing, I will use oral terbinafine in conjunction with Tolcylen.


Alan Bass, DPM, Manalapan, NJ



From: Dennis Shavelson, DPM, CPed


I was waiting for some innovative DPM to come up with new terminology that would completely eliminate "Biomechanics" from the podiatry dictionary. Here is the first: Durability.


What we actually need is new terminology for "subtalar joint neutral" and "pronation" (as other professions are accomplishing) in order to evolve biomechanics parallel to how we have evolved foot surgery, wound care, and regenerative medicine.


Dennis Shavelson, DPM, CPed, Tampa, FL



From: John M. Giurini, DPM


Thank you, Dr. Mullens. I could not agree with you more. I would go one step further: Stop the insults altogether. Unfortunately, society, from the highest levels of government to social media to town halls and school boards have forgotten how to discuss and debate issues rationally. This type of rhetoric makes no one look good or better, especially the individual handing out the insults. Dr. Mullens got that part right. As a profession, let's raise our standards above the unfortunate "new normal". Let's show other professionals and the public (yes, they read this). that we are able to disagree without being disagreeable.


John M. Giurini, DPM, Boston, MA



From: Elliot Udell, DPM


This issue has been discussed for quite a few years in this forum. Why is it that pharmacists can administer many vaccinations and podiatrists and dentists who give injections all day long, cannot? During the height of the first wave of the COVID-19 pandemic, some states in the U.S., including my own, issued temporary permission for podiatrists to administer COVID-19 vaccinations but only under the supervision of one of the other professionals.


A number of our colleagues took advantage of this and generously volunteered their time giving shots at mass vaccination centers. The fact that this did not lead to allowing us to give flu and COVID-19 shots permanently, does not do justice to the public, especially in areas where a podiatrist or dentist is the only healthcare professional that some elderly people see.  


Elliot Udell, DPM, Hicksville, NY



From: Stephen Musser, DPM, Ivar E. Roth DPM, MPH


Well done and written. I agree with every point you mentioned. For those of our colleagues who have been practicing less than 8 years, you will come to find this advice is well thought out and true.


Stephen Musser, DPM, Cleveland, OH


Congrats on your retirement George. Thanks for your advice. I would add though, that if you are conservative and do NOT sell surgery, you should inform patients and let them make the decision to have surgery or not; you will save yourself a lot of headaches. You will do less surgery, but since the patient made the decision, you will be safe from criticism.


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



From: Ron Freireich, DPM


Dr. Kass mentions a few of the many expenses that are rising, and this trend is certainly going to get worse. The other side of this perfect storm which has been brewing for many years is continued decreased reimbursements. Dr. Kass is 100% correct in saying that this model is not sustainable. The difference between healthcare and what other businesses are doing is that we cannot pass our increased expenses onto the consumer.


Not only are new graduates not going to be able to pay back student loans but they, along with everyone else in healthcare, are going to be unable keep up with paying any of their bills. It’s a no-brainer; when expenses are more than payments….it’s over.


Ron Freireich, DPM, Cleveland, OH



From: Barry Wertheimer, DPM, W. David Herbert, DPM, JD


Just a "thank you" to Dr. Daniel for his thoughts on what is good for America and not just podiatric medicine. Does anyone really think this country will survive with the course the left is on? It baffles me to think anyone who is capable of thinking rationally could accept the direction we are going.


Barry Wertheimer, DPM, Southern Pines, NC


I completely agree with Wes Daniel DPM about our national debt. I disagree with how long it will take to feel the effects of it. I received my DPM in 1976 and remember the inflation of the late 70s. I think what we will be experiencing starting now and continuing for who knows how long will definitely be much worse.


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



From: Cindy Medders, CMA


Our practice uses the J-Vac. We have ordered over 30 J-Vac units throughout the years. These units have been highly efficient, economical, and virtually maintenance-free. Dr. Ressler has always given us great customer service. These units were designed and sold by Jack Ressler, DPM, who is a practicing podiatrist.


Cindy Medders, CMA, Atlantic Foot and Ankle



From: David Secord, DPM


"I believe there are at least a dozen states which allow nurse practitioners to practice independently, which also includes full rights to write prescriptions. I believe changing a state’s practice act to allow podiatrists to treat the foot and ankle medically and surgically and also provide primary care may be politically feasible in some states." - Herbert


If you look at the infographic, the cause is being pushed that an NP is just as capable as a doctor or PA. Whether we, as physicians, agreed with this or not appears to have no bearing on the future of the NP and healthcare.


David Secord, DPM, McAllen, TX



From: Al Musella, DPM


We just ran into this. It looks like we can still download the 835 response file for free. The Medicare website has a free program that can print reports from these files.    


Al Musella, DPM, Hewlett, NY



From: Gretchen A. Lawrence, DPM


The North Carolina Foot and Ankle Society did provide a free series of webinars this year. Thanks to Jean Kirk and DeCarlos Dial, DPM and the residents of Wake Forest Baptist Hospital, the members of our state society got some free CME hours and face time among our members via Zoom. Also, the physicians from Triangle Vascular Care donated their time and expertise to better our society members.  


Finally, PICA always has free CME for their members because we can never have enough education on the legalities of our profession. And our society also provided a lecture on “Opioid Prescribing Patterns of Foot and Ankle Surgeons” to fulfill our state‘s opioid prescriber training for the year provided by the Wake Forest Baptist Residency Program. They are currently conducting research on this topic to better our profession and protect our patients here in the tar heel state! Thank you all!


Gretchen A. Lawrence, DPM, Shelby, NC



From: Steven Finer, DPM, Jack Ressler, DPM


Sorry, Dr. Malusky but carpet in treatment rooms is old school. When you visit your dermatologist, ophthalmologist, or internist - look down. You will see some form of tile which is washable.The C and C rooms should be vacuumed. Nothing will drive a patient away than stepping on an old toenail.


Steven Finer, DPM, Philadelphia, PA


I built out my last office in 2013. I selected rectified 24” ceramic tile. It was a great selection and we were always getting compliments from the patients. Rectified tile allows you to almost butt the tile edges up to each other which allows for a very narrow grout line (around 1/16”). Go with the largest tile possible, at least 24” to 36”. They do make larger but it becomes more costly to install. With larger rectified tile, the floor looks almost like a large sheet, providing your selection doesn’t have too much pattern or veining. Larger tile also makes the rooms appear bigger.


When choosing a ceramic tile, it is better to get a ceramic tile from either Italy or Spain as opposed to a Chinese product. Chinese ceramic tile tends to warp which will raise the corners of the tile edge. I used a Chinese ceramic tile and some of the edges of the tiles were slightly raised. It was never a problem and I’m the only one that really noticed it. The larger the tile, the more warping could occur. Flooring in an office is often a second thought but careful selection will make for a great appearance and provide long-lasting wear and satisfaction.


Jack Ressler, DPM, Delray Beach, FL

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