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01/27/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Robert Kornfeld, DPM
While I understand Dr. Roth’s point of view, I don’t think we are in need of a name change as much as we need better public relations. I can tell you that after 43 years as a podiatrist, I still often meet people who have no clue what our training and scope of practice is. But they do mostly know the training and scope of MDs. I have always believed that better PR would make the word podiatrist synonymous in the minds of the public with “medical and surgical management of the foot and ankle”. After all, that is what we do.
Robert Kornfeld, DPM, NY, NY
Other messages in this thread:
05/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Elliot Udell, DPM
Concierge practices are not always direct-pay practices. My doctor flipped his practice into a concierge practice. The deal is you pay an annual fee for the honor of being a patient but have to pay or have your insurance pay for each visit. The annual fee may be 2K a year. If the doctor has 1,000 patients in the practice, the doctor makes $200,000 a year before turning the key in his door. The rest is gravy.
I visited an eye center for a cataract procedure. They let me know that my insurance would cover the procedure, but the laser they use to open the capsule would cost me 2K out-of-pocket.
Elliot Udell, DPM, Hicksville, NY
11/22/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Howard Dananberg, DPM
In 1999, I published an outcome assessment study in JAPMA on 32 patients considered at or near medical endpoint with chronic lower back pain (CLBP). All were treated with custom foot orthotics designed to specifically mobilize the 1st MTP joint. These patients were followed for an average of 13.9 months. 84% reported substantial recovery as measured using the Quebec Back Pain Disability Scale.
In a separate study delivered at the 3rd World Congress on Lower Back Pain, I described the effects of the same type of orthotics on hip extension through the end of single support phase. There was an almost 50% improvement in range at follow-up (from 7 to 13 degrees).
It is the improvement in hip extension which is the most important factor in the podiatric management of CLBP. This improves pre-swing mechanics which ultimately relieves iliopsoas origin stress in the lumbar spine, disks, and intervertebral septa. Since this pathological motion is repeated thousands of cycles daily, resolving it produces outcomes which tend to be excellent. It represents a non-specific repetitive stress to the lower back region which cannot be relieved by other methods. Podiatrists should be at the core of every lower back treatment clinic worldwide.
Howard Dananberg, DPM (retired), Stowe, VT
10/11/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Alan Sherman, DPM
In response to my esteemed colleague and good friend Wenjay Sung, I recognize the particular focus and expertise of both ABPM and ABFAS and would prefer that these boards find a way to merge, rather than compete with each other. Having multiple boards creates division in the profession and confusion in the medical community and among the public. Podiatry is its own tribe – we don’t need more tribes within us. I’m in favor of simplifying our board certification by consolidating into a single board that represents all of podiatry. Certainly that board should maintain high standards, offer CAQs or whatever they want to call them to recognize additional expertise outside the basic standards that they establish for fellowship, and ultimately include all podiatrists who seek board certification and measure up to its established standards.
Alan Sherman, DPM, Boca Raton, FL
09/05/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Alan Sherman, DPM
The two letters from Drs. Chaskin and Name Withheld (FL) regarding the “In-Person Requirement for CE?” were usefully provocative and raise interesting points. I fail to see what is better or more desirable in general about live delivered lectures as far as their educational impact and professional improvement effectiveness. In general, the ability to view on-demand lectures in portions and at times most suitable to the learner’s attention, and the ability to rewind and review sections, makes them a more effective education experience. I ask PM News readers – how much live TV do you watch? For me, it is only sports, as I am more “entertained” by the excitement of it being live. Everything else, I record and watch on demand. Why are we dealing with CME lectures differently?
Yes, lectures by our favorite teachers can be entertaining for some of us and I do enjoy and appreciate the...
Editor's note: Dr. Sherman's extended-length letter can be read here.
11/01/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From Elliot Udell, DPM
I understand where Dr. Jaffe and others are coming from. The COVID-19 pandemic is not over, and people who are undergoing chemotherapy or have other conditions that compromise their immunity should not under any circumstances mingle in large crowds, It’s not worth it. On the other hand, big conventions make huge amounts of money from the convention booth rooms where companies pay large amounts to display their products.
Live meetings are also educational in their own right because we all learn about new products from these vendors at conventions, and in many cases, get to try out samples of new products. The bottom line is that until the pandemic really becomes history, conventions should allow doctors to choose between attending in-person and on the computer.
Elliot Udell, DPM, Hicksville, NY
10/28/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Steven Finer, DPM
Actually, in the 1990s, Medicare’s Pennsylvania payer set up an electronic system which was DOS-based. It was not podiatry-specific as you would load in codes. You would receive updates four times a year. Other components, such as deductible information did not exist. You could buy them from software companies for an ongoing fee.
Also, tracking software for procedures performed was not included. Stacks of small checks would arrive and had to be hand deposited. Two to three hours would be wasted with these checks. Slowly, other carriers came aboard. There was no such thing as electronic banking - only handwritten checks for payments. Today, with a smartphone, one can track 95% of their daily activities.
Steven Finer, DPM, Philadelphia, PA
02/15/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Robert Kornfeld, DPM
I wholeheartedly disagree that podiatry needs to remain a medical specialty with a plenary license and DPM designation. I have been a podiatrist for 40 years and have listened to this conversation ad infinitum. Unless and until we are MDs or DOs, we will never have parity. I think it's ludicrous to believe that given the choice, no one will opt to become podiatrists. That is simply an empty argument. Students will fill all specialties as per the available number of residencies over time.
I am at the tail end of my career and it will never matter to me one way or the other, but my opinion is that podiatry as a profession will die if it is not absorbed into allopathic or osteopathic medical school training programs.
Robert Kornfeld, DPM, NY, NY
12/30/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Dennis Shavelson, DPM
I can best distill Dr. Ribotsky’s query by stating: “Why would we want to surgically create a hallux rigidus as a primary treatment when FHL, hallux limitus, and hallux rigidus are root causes of biomechanical foot and postural pathology in civilized mankind?
I can only answer Bret by supplying disruptive terminology and practice habits into the mix: #1 If a higher rearfoot or forefoot SERM-PERM interval exists, that disruptive, superfluous motion must be reduced or eliminated using some combination of props, surgery, and joint and muscle engine training or therapy.
#2 If a lower rearfoot or forefoot SERM-PERM interval exists, then additional motion must be supplied using props, surgery, or joint and muscle engine training or therapy. This can only be accomplished by consultants with enough education, experience, dexterity, and passion in their respected area(s) of specialty to eliminate bias and economic drive.
Dennis Shavelson, DPM, NY, NY
12/14/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Multiple Respondents
To be clear: We can conclude from this article that masks do not protect the individual who wears it. We cannot conclude from the article that it does not protect the public. In other words, the study does not look at whether an infected individual who wears a mask would be less likely to infect others.
Matthew Roberts, DPM, Miami, OK
With respect to Dr. Purdy's posting, I would like to point out two things: 1) The study that he refers to was paid for and sponsored by a non-medical foundation whose political bias may have come into play, in my opinion. 2) A November 24, 2020 research paper by the Mayo Clinic: "Mayo Clinic research confirms critical role of masks in preventing COVID-19 infection". I think I'll follow Mayo's findings.
Stephen Doms, DPM, Hopkins, MN
So that same Danish study from April has been discovered again by someone else. What else you got? I think Dr. Purdy should show the study to his OR supervisor and tell her he’s not going to wear a mask in the OR anymore.
Ron Werter, DPM, NY, NY
Editor's note: Additional posts on this topic can be read here.
02/04/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Alan Sherman, DPM
I want to respond to Stephen Kominsky’s message critical of the APMA’s and podiatrists’ efforts to educate the lay public about what we are and what we do. Throughout my 42 years as a podiatrist, I’ve seen so many efforts by the APMA and state associations to educate the public. I don’t believe that it has done no good at all, and I don’t thing Dr. Kominsky is saying that. I’m sure it has helped. But we must acknowledge that what we tell the public about ourselves is not going to have the credibility of what they observe on their own, or are told by trusted sources.
In this age of ubiquitous media, we have all developed sophisticated filters and have learned to challenge many sources of information that 100 years ago would have been...
Editor's note: Dr. Sherman's extended-length letter can be read here.
09/14/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Steven Kravitz, DPM
Dr. Udell’s commentary on the original article from Dr. Levy is right on target. Dr. Allen Jacobs is a major proponent of podiatrists as true physicians, practicing as expert specialists in foot and ankle medicine. In that regard, my commentary and suggestions on the topic are as follows.
Blood pressure measurement should be standard at all, if not most office visits. Informational pamphlets from other medical societies describing different pathology that affects foot and ankle provides information to patients and the ability for the podiatrist to make appropriate referrals. A yearly annual history and physical exam should be taken to update records and follow up on patient standard health. This leads to referral to appropriate colleagues, provides better patient care, decreases patient morbidity, and increases your visibility in the medical community.
All of this reflects good quality practice and the very best method to build a stable practice in your medical community.
Steven Kravitz, DPM, Pfafftown, NC
07/08/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
RE: Preventing Suicides of Podiatric Residents
From: Gwen S Greenberg, DPM
Robyn Symon is a documentary film maker who has been a champion of physician and medical student suicide prevention. She has created a film called Do No Harm which she has presented at many medical conferences and hospitals. She will be coming to our local hospital in September. As the parent of a second year medical student and a first year internal medicine resident, this is really scary. Here is the trailer for the video. A screening can be scheduled at this website: http://www.donoharmfilm.com/screenings.
Gwen S Greenberg, DPM, Allentown, PA
08/16/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Joel Lang, DPM
Last week, I was approached by a woman who looked vaguely familiar. She asked if I remembered her and I told her she looked familiar, but I could not remember her name. She identified herself and told me that I had operated on her foot many years ago. (I am now retired 19 years.) She followed up by saying “Best surgery I ever had.” It made my day! Yes, I’m proud of what I have accomplished as a podiatrist.
Joel Lang, DPM (retired), Cheverly, MD
01/26/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: David S. Wolf, DPM
I recommend Active Management which has done our billing and collections for over 10 years. They are very knowledgeable and responsive about podiatric billing and collections, with excellent follow-up.
Disclosure: I have no financial involvement with Active Management..
David S. Wolf, DPM, Houston, TX
08/28/2015
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Paul Kesselman, DPM
I read the paper referenced by my two esteemed colleagues as well as their comments. This is in fact an excellent start for evidence-based medicine (EBM) papers which podiatry desperately needs. When my colleagues meet with insurance executives, the paucity of these types of papers are often the most obvious hurdles we have to overcome to convince medical directors that orthotics are worth paying for (or continue to pay for) .
Say what we want how custom foot orthotics save money by avoiding costly surgery and post-operative complications; they want to see peer review studies proving...
Editor's note: Dr. Kessleman's extended-length letter can be read here.
08/21/2015
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Steven Selby Blanken, DPM
With all due respect to Dr. Lang's comments, one must understand that when Dr. Lang retired, patient's did not have huge co-pays and/or deductibles. It is very common now that patients may pay a majority of their healthcare visits and/or surgical or DME. My credit card income has gone way up and my personal check and/or cash income has gone way down. We must now train our staffs to check patient benefits prior to the visits. We thus train our patients to come to the practice expecting them to pay all amounts due at the time of each service. Without that mentality, we will not be able to pay our bills. I commend everyone who tries to reduce their merchant credit charge fees.
I feel that the 4-5 percent in fees we have to pay for this service is too high and can be negotiated to at least half of that. Please also note that the merchant fees increase with credit cards that have bonuses involved with those companies. We start out every year with a goal to do better (increase in income and healthcare delivery). The best businesses that thrive in this economy are the ones that cut their expenses lower and lower, thus potentially increase gross and net income. Now only if we can cut our sequestering penalties or MU decreases... That would be nice!
Steven Selby Blanken, DPM, Silver Spring, MD
07/22/2013
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
RE: Cast Cutter and Malpractice (Joseph Borreggine, DPM)
From: Martin V. Sloan, DPM, Keith L. Gurnick, DPM
This case is so bogus. The attorney's allegation that a professional "medical grade" cast cutter somehow stops its cutting action once the cast is penetrated while an "inexpensive cast cutter" can cause lacerations even after penetrating the cast is preposterous. We've all explained to the wide-eyed patient as we're about to cut the cast that the saw blade doesn't spin round and round, and therefore is less dangerous than it appears.
But we all know that the success of a procedure is directly related to the skill of the doctor. I own both a Martin Cast Cutter and a Stryker cast cutter. In both, the cutting action continues as long as the switch is on. If not used properly, either (like the less-expensive "non-medical" devices) can cause an abrasion or laceration.
Martin V. Sloan, DPM, Rockwall, TX, martinsloan@me.com
Irrespective of what type of "cast cutter" you use to remove a cast, and without sounding like I am sanctioning or endorsing any brand or style of "hardware store" machinery, please make sure whatever you are using to remove, modify, or window a cast has the appropriate type of blade to remove a plaster or fiberglass cast, and cuts by "oscillating" and not by a unidirectional circular rotation. This lessens the chance of a cut or burn, or any injury to your patient.
Keith L. Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
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