04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Ron Freireich, DPM
I agree with every last word that Dr. Kornfeld writes in his post. The two questions he asks that I feel are most compelling are...Why is it that this problem is not front and center of every discussion? And why is there not a complete commitment on the part of this profession to address the misery, exploitation, and abuse that most podiatrists experience? Yes, why is that? Every stakeholder in medicine should be approaching this issue as if we were fighting for our last breath and nothing else, because I think we just might be. In fact, we may be at the point of no return.
In addition to all the physician issues mentioned by Dr. Kornfeld, I looked up how various hospitals are doing financially here in Cleveland. Four major Northeast Ohio health systems ended 2024 with budget shortfalls in the millions. One major hospital reported a loss of $142 million in 2024. That came after operating losses of $256 million in 2023 and $302 million in 2022. Lately, I have been paying more attention to what I am getting reimbursed by insurance companies and I am utterly shocked. None of this is sustainable for anyone in the medical field. I really don't understand why providers of medical care are not part of the solution for this country's financial healthcare problems, while insurance companies and their investors continue to get rich. If you keep having to bail water out of a ship, the ship is going to eventually sink.
Ron Freireich, DPM, Cleveland, OH
02/25/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
RE: Redefining Roles in Podiatric Care: Exploring the Potential for a Standardized Foot Care Assistant Model
From: James H Whelan, DPM
The landscape of foot and ankle care is evolving. With an aging population, a growing number of patients with diabetes, and shifts in podiatric training emphasizing surgical intervention, there is an increasing need to ensure continued access to high-quality foot care while reinforcing the role of podiatric physicians as the foremost experts in foot and ankle health. A topic of growing discussion within the profession is the expansion of routine foot care services provided by non-podiatric healthcare professionals. While this raises concerns about scope of practice, it also presents an opportunity to explore structured, podiatrist-led models that enhance patient care and optimize the efficiency of podiatric practices.
One potential solution is for professional organizations such as APMA and ACFAS to evaluate the feasibility of developing a standardized Foot Care Assistant (FCA) role—a structured position within podiatric practices that allows trained professionals to...
Editor's note: Dr. Whelan's extended-length letter can be read here.
12/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Paul Kesselman, DPM
Once again, the insurance industry has sent the exact wrong message to the public. Rather than take this murder as a wake-up call to them to respond to the public's need for more transparency, they have chosen to insulate themselves even more. As Kevin O'Leary from Shark Tank said, "Putting up fences around headquarters and providing their executives with more security is not the message the public needs to see."
As for my friend and colleague Jon Purdy, his comment regarding Medicare losing money and allowing people to save money on their own to use for healthcare, fat chance that will work. Most people are not that disciplined that they can do that, and that was the whole purpose for Social Security and Medicare in the first place: To ensure that people in later life would have a safety net to provide to them.
The problem is that Medicare was not set up to be a profitable entity, but the Medicare Part C plans were set up to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
01/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Cary Wolf, DPM
We follow CMS guidelines. Care provided is a medical necessity. My point is not about coding or medical necessity. The point is that there is a clear bias against hospice patients receiving care as Medicare feels because they’re in hospice and at the end of life that they do not need the care.
Some patients go on and off hospice and some are in it long-term (years). Also, Medicare sets a limit on the total number of hospice patients that can be treated and a set dollar reimbursement limit.
Cary Wolf, DPM, West Bloomfield, MI
01/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Jeff Root
In response to Dr. Teitelbaum’s question about foot scanning for Android users, our advice to clients who don’t own iPhones and who want to scan feet with a mobile phone is to purchase a refurbished iPhone with facial recognition technology for about $200, connect it to your Wi-Fi network, and use it as a dedicated foot scanner. You don’t need to pay any cellular provider fees, and after the initial purchase, there are no other costs in order to have this tool available to you.
Jeff Root, President, KevinRoot Medical
01/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Ann Ganley
May I thank PM News for printing the letter “The Legacy of James Ganley, DPM” by Allen Jacobs, DPM. It was brought to my attention by a former resident and the podiatrist wife of our grandson. Since my husband, Jim, died of myelogenous leukemia at the age of 62 on Oct 4, 1992, our family is pleased that he is being remembered after all these years.
Allen Jacobs, DPM wrote for the purpose of improving the daily practice of podiatrists today with his thoughts and insight. He highlighted many of Jim’s areas of expertise. He was the ultimate diagnostician. Also, Dr. Jacobs’ reference to William Osler (which I had to look up) was quite a compliment. Thank you for that statement.
Jim was quite a storyteller. Our family enjoys retelling his stories and those of our own to remember him at the family dinner table. Thank you to Dr. Jacobs and the other doctors who contributed with their reflections as well.
Ann Ganley
09/12/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: APMA Board of Trustees
Comments about APMA’s testimony presented incomplete and misleading information. APMA is the greatest advocate for this profession, driven by the expressed needs of its members. Let’s examine the facts.
After the APMA bylaws revision adopted by the House of Delegates in 2020, the Joint Committee for Recognition of Specialty Boards (JCRSB) was transferred completely to the Council on Podiatric Medical Education (CPME). CPME now has a Specialty Board Recognition Committee (SBRC) responsible for the initial and continued recognition of specialty boards. CPME documents 220 and 230 govern this activity, and an ad hoc committee of CPME is rewriting these documents. The ad hoc committee set up a listening session to solicit input from the interested stakeholders regarding these...
Editor's note: This extended-length letter can be read here.
02/07/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Keith L. Gurnick, DPM
Those of us who did not use or offer the "Cartiva" all lost many surgical patients who first sought out our opinions for surgical treatment for stiff or swollen or painful osteoarthritic 1st metatarsal phalangeal joints (hallux limitus, hallux rigidus).
We gave them "patient specific" and "condition specific" current surgical options available of either a cheilectomy, shortening or PF osteotomy, joint replacement with an artificial "real" implant or joint arthrodesis-fusion, only to have some of those patients end up getting a Cartiva procedure elsewhere that went on to failure. How do we know? It's because some of those patients lost confidence in their "Cartiva" surgeon and returned to our offices for help. We spoke with those patients and they told us what they were told and why they had the surgery elsewhere. Broken promises.
Patients chose this procedure because they were told that it was less joint destructive, had quicker healing, had better range of motion, was salvageable in case of failure, and that the published research papers had shown excellent results. All of this has shown to be untrue for most patients. It is a shame that patients are so easily influenced by "direct to patient marketing" from the manufacturer, and also by the foot surgeon and on their websites as well and how the public is all too often mislead.
Keith L. Gurnick, DPM, Los Angeles, CA
02/04/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Paul Kesselman, DPM
Kudos to Dr. Allen Jacobs for a superb essay on the issues surrounding Modern Vascular. Many of our colleagues in all fields of medicine steer their patients to facilities such as ASC where they are part owners. More recently, an orthopedic implant manufacturer was convicted of incentivizing an orthopedic surgeon by providing millions of dollars of free implants for surgeries performed out of the USA. In return, the surgeon also performed many of those same surgeries here in the U.S. using these same implants. Just today, an ENT surgeon was also found guilty of re-using sinus implants costing the tax payers millions of dollars.
I wholeheartedly agree (as we all should) with the last paragraph of Dr. Jacobs’ recent essay, that is “The decision not to act is a decision.” For those who wish to act responsibly, contacting a healthcare attorney is the responsible measure to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
11/28/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Thomas Silver, DPM
I remember the wise words of an instructor who said, "when a patient has knee pain, our job is to determine if the pain is coming from the knee, above the knee, or below the knee. If it's coming from below the knee, then we can fix it; otherwise, refer them to the appropriate specialist who can fix it." I think the same goes for back pain. If it could be coming from the feet, then (hopefully) we can fix it. Over the years, I have found it to be a real bonus when I get patients into orthotics and they tell me that their knee, hip, and/or back pain went away too!
Thomas Silver, DPM, Golden Valley, MN
11/25/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Bruce Smit, DPM
I too recognized the hazard of getting older as I aged. Many years ago as a young man and before my medical training, I played in a rock band in the Chicago area that played all the top 40 hits of the time. We were, thankfully, successful competing against a plethora of garage bands all who wished for "Rock and Roll success". We played record hops with the top DJs in Chicago's radio industry. We played with Herman's Hermit's and Wayne Fontana and the Mind Benders on stage at Chicago's Arie Crown Theatre in McCormick Place. We recorded a 45 rpm record at RCA Victor studios, and as it was time to release the single, The Beatles arrived!
55 years later, I ran into the drummer by accident. He was still playing his guitar as a one-man band in the local lounges. We decided to "regroup" and with the help of two more formed a cover band. We have a regular gig at a local bar/grill and host about 75 guests at a time. What a blast we are having at age 76 years, grey hair (no pot bellies), and fortunately good health.
Bruce Smit, DPM, Frankfort, IL
08/26/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Steven D Epstein, DPM
Name Withheld's comment about obtaining used open vials from the OR while the nurses look the other way is a direct violation of safe injection practices. This CDC document explains that multi-use vials should be dedicated to a single patient, whenever possible.
In many states, such as Pennsylvania, where I practice, all it takes is a single anonymous complaint from a patient, employee, or other person to the department of health that you are doing something wrong and that will bring down a surprise inspection of your office, in which everything in your office is fair game for them to look at. This then can result in immediate license suspension. This is done by the health department's administrative power without due process, and without any specific regulations within the podiatry practice act having been violated. Then you have to appeal to get your license back. Many docs would be surprised at what a bunch of nurses and epidemiologists might consider substandard, such as your flooring material and the kind of products you use for office cleaning. All of these things are covered in a host of CDC and other relevant agency documents.
It would be very easy for Name Withheld to get into trouble. An employee of the hospital who disagrees with another employee's practices could simply lodge that complaint.
Steven D Epstein, DPM, Lebanon, PA
10/07/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Estelle Albright, DPM
You are correct in stating, "A simple scratch causing a break in the skin" could lead to consequences...particularly if it occurs in the act of drilling toenails or using a Dremel drill with sandpaper burr...one small scratch or scrape with a power tool like a Dremel causes a serious issue." Why not instead treat the underlying fungus problem: Be the physician that you are.
Nothing anyone can say will change the minds of those who insist on using this archaic way of treating patients' fungal nails. I wonder how this would stand up in court..."So, doctor, you use a woodworking tool to treat patients, is that correct, doctor?"
Estelle Albright, DPM, Indianapolis, IN
03/11/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Gary S Smith, DPM
The issue of podiatrists obtaining parity with lesser trained medical professionals that have a broader spectrum of care than we do has come up many times. Many people would like to see this change but instead of doing anything, everybody sits back and expects podiatry "groups" that have nothing to gain and everything to lose to do it for us. If we're going to make a move, now is the time. There is a huge shortage nationwide in healthcare providers. Many places only have PAs treating patients with no MD coverage and everybody looks the other way.
I have thought about starting a dialogue with legislators in Pennsylvania about this but I have some reservations. If I was able to get it approved in some manner to where DPMs could treat...
Editor's Note: Dr. Smith's extended-length letter can be read here.
12/08/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
RE: Medical Marijuana and Podiatry
From: Jay Kerner, DPM
As per my previous posts regarding prescribing medical marijuana for such conditions as diabetic neuropathy, ishemic pain, and debilitating arthritis, I again wish to raise my concern that as podiatrists, we de-value our profession by not retaining parity with the other medical professions.
As stated in Newsday last weekend, as of November 29th, nurse practitioners may certify patients for medical marijuana in New York State. Physician assistants will no doubt eventually be included, as they are already licensed to prescribe...
Editor's note: Dr. Kerner's extended-length letter can be read here.
04/11/2014
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: George Stephen Gill, DPM, MBA
Kudos to Lawrence Rubin, DPM - academic clinician extradonaire! To this day, his diagnostic radiology course (62/63 ICPM) resonates superior every time I view a film or do a differential diagnosis of osseous pedal pathology. Thank you Larry ...just thought you and others should know!
08/12/2013
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
RE: Vasyli Medical Affiliates Program (Eric Simmons, DPM)
From: Brandon Noble
Regarding the concern of the legality of the Orthaheel referral program and the referral bonus paid – we at Orthaheel have performed our due diligence researching law and discussing the program with governing bodies of healthcare professionals before launching the program to ensure we are providing a legal and ethical program to our valued customers.
The goal of the Orthaheel referral program is to reward physicians for referring patients to Orthaheel with the goal of creating a great experience for both the patient and physician. If any of you have concerns or question regarding the program, we would be happy to answer them. Please feel free to contact us at bnoble@vionicgroup.com for more information.
Brandon Noble, CO, LO, Director of Medical SalesVionic Group, bnoble@vionicgroup.com
