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RE: Overcoming the Influence of the AMA

From: W. David Herbert, DPM, JD,


In 1967, the AMA declared that it was unethical for an MD to refer patients to chiropractors, but today chiropractors can obtain privileges on hospital staffs to perform spinal manipulation under anesthesia. A half dozen states allow psychologists to prescribe psychotropic drugs and at least one allows optometrists to perform lasix surgery. We know that a number of states allow nurse practitioners to practice independently.


Obviously, the influence of the AMA to block legislation by other professions trying to enlarge their area of practice is not what it used to be. Maybe podiatric leaders should hire some of the same lobbyists the chiropractors, optometrists, and the nurses use!


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

Other messages in this thread:



RE: Politics and Healthcare

From: W. David Herbert DPM, JD 


I attended law school in Sacramento, California in the 1980s. My law school offered an elective course which allowed us to work with an attorney who was a lobbyist. One of the students in my class was an optometrist who was working with the optometrists' lobbyist. There was not an attorney lobbyist representing podiatry in the state legislature at that time. I decided to work with the attorney lobbyist representing the chiropractors. One of the issues at that time was whether a chiropractor could order an MRI at a hospital. Organized medicine was very much against this and and a former president of the California Medical Association (who was a retired radiologist) was flown up from Los Angeles to testify against it.


The assembly committee on health had a member who was also an optometrist and very much in support of the chiropractors' Bill. By being prepped by both the chiropractors and optometrists  lobbyists, he was able to effectively question the retired radiologist when he was testifying. Eventually, the Bill was passed and signed by the governor. Remember, even if you do not like politics, politics affects you personally and professionally every day!


W. David Herbert DPM, JD, Billings, MT



From: Jeffrey Kass, DPM


I agree with Dr. Herbert’s opinion. If things aren’t changing, it would behoove someone to change strategy or legal representation. One would think that new legal counsel would be hungry to show their worth. Most other professions are advancing their legal scopes and our profession remains pretty stagnant in comparison. I notice most of the doctors in my state who increase their scope are the ones that leave the state. But, yet the state societies keep the same lobbyists and attorneys. Makes one wonder. 


Jeffrey Kass, DPM, Forest Hills, NY



From: Morton I. Altman, DPM, Philip Radovic, DPM


As a retired podiatrist, residency director, and researcher, I am no longer surprised at what level pharmaceutical companies, medical supply manufacturers, and others will go to sell the public on their product. Sad what has happened.


Morton I. Altman, DPM, Gig Harbor, WA


I recently promoted one of these Lapidus systems and decided to stop as I share the same frustration as Dr. Oloff. Are aggressive marketing strategies and doing an end run directly to consumers improper? It’s what pharmaceutical companies began some 20 plus years ago when they successfully lobbied congress to allow advertising medications directly to consumers when it was considered taboo…much like advertising tobacco is not allowed today. Although some of these systems have inventive clamps and guides, their function is easily reproducible with conventional instrumentation. One can argue the benefit of informing the public in a general sense; however, the cost and complexity of these systems, in my opinion, are unnecessary.


Philip Radovic, DPM, San Clemente, CA



RE: The Commercialization of Medicine

From: Lawrence Oloff, DPM


I would like to share my frustrations with the commercialization of medicine. I grew up in an era of medicine where surgical equipment companies would introduce doctors to their newest gizmo via reps and meetings. Some of these were true advancements, and other not. Doctors would attend labs, listen to experts, and would then incorporate new devices/implants into their practice that they felt had merit. We have now entered an era where companies target the consumer.


In essence, a backdoor approach to the doctor. Promises of better results and faster recoveries have flooded the marketplace via the Internet, and...


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



RE: The Power of Your Patients and the Media

From: Paul Kesselman, DPM


The power of the media and your patients working together can reverse payment denials. A suburban Chicago area resident recently went on TikTok in order to obtain a reversal of a $40K payment denial for kidney tumor surgery. This, even though the hospital and physician had obtained pre-authorization from Anthem. This recent story shows the power that you and your patients along with the media can leverage over these giant monopolies.


One cannot expect to generate much empathy over small denials typically seen in many physicians’ offices. However, lumped together, a union or group of patients filing a similar action against an insurance giant may be able to leverage equivalent results. 


Paul Kesselman, DPM, Oceanside, NY



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



From: Martin M Pressman, DPM


I have also been summarily rejected from these surveys because of my age (75) and years of practice (47). These “surveys” are not gathering information for academic purposes. They are underwritten by pharma or industry and aimed at practitioners to identify practice patterns for the purpose of selling them on the industry’s own product. They know we seasoned  practitioners generally don’t fall for those games. I take that as a compliment.


Martin M Pressman, DPM, Summerville, SC



RE: Difficulty Scheduling PT after Surgery

From: Howard Bonenberger, DPM


I had surgical patients schedule their post-op PT well in advance of the procedures. This is especially important for range-of-motion work. You can easily predict the diagnoses and PT needs for the orders for nearly all surgeries. If modifications are needed, you simply update the orders as you would anyway but at least your patients are scheduled.   


Howard Bonenberger, DPM, Retired, Hollis, NH



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:  Ira Meyers, DPM


I strongly disagree with the post from Robert Schwartz, CPed, regarding biomechanics and footwear. When a patient comes to the office, whether it be for a painful hyperkeratotic lesion, foot ulcer, or any type of overuse injury, the first thing that is checked are the shoes.


With the great variability with different types of running shoes, it is especially important to check shoes. There can be is much as a 20 mm drop difference between different types of athletic shoes, which significantly changes the whole biomechanical exam. Shoes should be the first things that are checked, followed by a static biomechanical exam, then an active biomechanical exam.


In short, lower extremity biomechanics cannot be evaluated without evaluating footwear.


Ira Meyers, DPM, Huntingdon Valley, PA



RE: Stepping up Podiatry's Role in Fall Prevention

From: Ben Pearl, DPM


Many of us do not have to look far when it comes to the devastation that falls can have, particularly as we age. We all know the stats. The APMA just reminded us in their summer newsletter that 30-40% of adults 65 and older will fall. Falls are the leading cause of death related to injury in adults 65 and over, with an increase in morbidity and mortality after a hip fracture from an errant step. According to the CDC, $50 billion is the cost estimate to the U.S. healthcare system alone for the ripple effect of medical costs related to falls. This has only been made worse, no doubt, by the change in habitus that has occurred during the pandemic.


When my mother was young, she was graceful as an equestrian and diver. She skied by the time I came along but slowly succumbed to the steady decline that many Americans suffer. I would implore her to take a walk and get moving. I noticed that her walking became more unsteady over the years. She did not take me up on my “prescription” but I did get her to walk occasionally when I came over. I got a call one evening that my mom had fallen, broken her neck, and suffered a massive stroke.


Many times these tragic events happen with the cardiac or clot event preceding the fall but here’s the thing; John, her significant other, saw her hook her ankle on the low lying coffee table as she was carrying a tray of plates from the living room back to the kitchen. Perhaps if she had done some modest exercises at home, her fall may have been prevented; if nothing else, walking more regularly to try to control her weight and help her heart health.


Ben Pearl, DPM, Arlington, VA



RE: How Insurers Exploited Medicare for Billions

From: Richard Rettig, DPM


This article from the NY Times speaks to how the Medicare Advantage plans use our chart reviews to glean extra diagnoses for higher payments. We already know that. But there is additional information regarding the extent that they have been found guilty of fraud on account of this. Also the relative penetration of each plan in the marketplace. Also the percent of members in these plans geographically.  And that besides gleaning our charts, some have sent doctors and nurses to patients homes to try to find even more diagnoses. And some pay primary care doctors bonuses based on the number of serious diagnoses treated, financially encouraging them to add as many as possible.  


Richard Rettig, DPM, Philadelphia, PA



RE: Recent Changes in ABFAS Recertification 

From: Richard Silverstein, DPM


With respect to the recent changes for recertification that have been instituted by ABFAS: My board certification expires in August 2025. I went to the website and it instructed me to take 4 of the 30 question tests prior to the expiration date. I did so and maintained above the required MDT P-value. For all intents and purposes, I do not have to take another test until the end of 2025 as I have met the requirements.


The whole point in the change in format was to have us keep up-to-date periodically as opposed to having us study for one test at the end of the certification period. I called to ask if I could continue to take the tests for practice and I asked to make sure they wouldn’t be officially scored. I was shocked to hear that they would have to be scored, meaning the next test or 5th would replace the first one I took. This makes no sense.


At a point where I don’t have anything to achieve by taking them, other than testing my own knowledge and keeping up-to-date, why not just designate us in the system as having fulfilled the requirements and now let us take the exams for practice? Isn’t that the whole point, to keep us reviewing and learning on a continual basis? ABFAS is missing the opportunity to allow docs to continue to use the LEAD testing system even after they fulfill their obligations.  


Richard Silverstein, DPM, Havre de Grace, MD



RE: October is Breast Cancer Awareness Month

From: Elliot Udell, DPM


Twelve months ago, I was diagnosed with breast cancer. Luckily, I caught it early and after surgery radiation and medicines, my medical team is optimistic.


The reason why I am public about my medical history is to make as many people as possible aware that this disease exists in both sexes and we should all be checking ourselves in the appropriate way as advocated by the American Cancer Association. For women, it is an annual mammogram and for men, any sign of lumps or bumps in the breast area warrants an immediate visit to one's primary care physician. 


Elliot Udell, DPM, Hicksville, NY



From: Steve Gershman, DPM


I use a billing company in Media PA, Clayburn Medical Billing. Margaret Clayburn is excellent with podiatric billing at a fair price.  


Steve Gershman, DPM,  Auburn, ME 



From: Jack Ressler, DPM 


I use sanding discs from Moore. If you are referring to the "pinhole" design that needs a small screw inserted into the mandrel, I would highly recommend the snap-on disc that simply attaches to a snap-on mandrel. Order the course garnet. They are much more efficient. I get mine from Federated Medical Supplies, formally known as Karasity's Medical. 


Disclosure: I have no financial relations with this company.


Jack Ressler, DPM, Delray Beach, FL



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



RE: NY State Seed Funding Grants

From: Al Musella, DPM


I came across something interesting. This is a generous grant only for those people who have a business in NY State that started on or after Sept 2018 and grossed between $5,000 and $1,000,000 last year. If you qualify, they will give you from $5,000 up to $25,000 depending on your last year's income. Click here for details!


Al Musella, DPM, Hewlett, NY



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: Allen Jacobs, DPM


The derisive commentary of Dr. Lee Rogers with regard to the AACPM was the classic strawman argument so often used by politicians rather than academics. I find myself in agreement with Dr.  Oloff. The comment was insulting to our profession.


Many of the old podiatrists such as Dr. Oloff have watched the incredible growth of this profession and concurrently, the increasing acceptance and incorporation of podiatry in medicine. Young practitioners cannot possibly imagine the time past when a podiatrist could not

prescribe medications, administer an injection, perform surgery, or...


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



From: Lawrence Oloff, DPM


Every leadership group in our profession has weighed in on the CAQ in surgery proposal by ABPM, and the response has been a resounding NO. Nevertheless, Lee Rogers has continued to push this agenda forward. One really has to begin to question the intent of a proposal that is rejected by the entire profession? Deft ears? Self-aggrandizement?


Why do we need board certification? It has two purposes:

- “Board certified doctors demonstrate their desire to practice at the top of their profession and deliver high-quality care to...


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



RE: The Commercialization of Medicine

From: Steven Finer, DPM


Does one think that we are the only profession fighting the commercialization of their products? When I was a kid and needed glasses, one entered the sanctum sanctorum of the optician. Today go on line or to Costco, and on and on. Braces are delivered to your door by some dental lab. There is an IV infusion store near me that gives you vitamins and other life improvement products. Of course they have a physician to sign off. It’s all about the dollar, the lack of respect for the medical profession, and the rise of social media. Read the book, The Tipping Point. 


Steven Finer, DPM, Philadelphia, PA



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



FromKeith L. Gurnick, DPM


As podiatrists, we are all very aware that there is available to the consumer a plethora of shoe inserts to help alleviate pain. This includes non-custom, non-prescription products that can be purchased off-the-shelf in retail stores or on-line and can include flat cushioned insoles, contoured cushioned foot supports, and hybrid devices that are both supportive and padded. Also, available are products from retail "foot comfort" stores where salespeople can guide the consumer towards purchasing various pre-manufactured products that also might be soft, padded, or more often made of semi-rigid plastics and are more supportive. These "salespeople" are not doctors and cannot diagnose nor prescribe custom orthotics. Frankly, I don't know how they get away with what they do.


Custom prescription foot orthotics are only available from licensed professionals and doctors or laboratories with a prescription. Therein lies the difference that should be explained...


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



RE: Meeting Discounts for MDs and DOs

From: Jeffrey Kass, DPM


“Shuffle off to Buffalo” is a surgical and medical update seminar put on by the Western Division of NYSPMA. Their fee structure to attend the seminar is as follows:

                                                           Before 9/1/22       After 9/1/22

APMA , OPA Members, DO, MD:      $ 325                           $ 500

Non-Members:                                    $ 525                            $ 625


I don’t have any issue when an association event charges more money to a non-member, but it is a little strange to charge a DO or MD the member fee. Are DOs and MDs now “grandfathered" into the NYSPMA?


All New York podiatrists do not enjoy the same scope of practice. We have been told time and again that this is due to opposition from the orthopedic society and dermatology societies. If they want to prevent you from advancing your career, why would you assist them with theirs? Of course, this is going under the assumption that orthopedists and dermatologists care to participate in the seminar in the first place.


Jeffrey Kass, DPM, Forest Hills, NY 

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