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06/03/2023
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Advice for New Graduates
From: Glenn Shintaku, DPM
As this is graduation season, I would like to wish all the podiatry school graduates and residents well as they embark upon the next phase of their careers. I am retired but I would like to share with the new graduates a modification (of which there are many) of an old proverb which I hope is relevant and will help them in their careers and life:
"If you know that you know, stay humble.
If you know that you don't know, you are wise.
If you don't know that you know, you need a vacation.
If you don't know that you don't know, you are dangerous."
Congrats Class of 2023!
Glenn Shintaku, DPM, Gardena, CA
Other messages in this thread:
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Brian Wm. Zale, DPM
I was sued some 25 years ago by an attorney who I believe just hated podiatrists. PICA was my medical liability company at that time. The patient had bilateral bunionectomies by another podiatrist previous to seeing me. She also had some plastic surgery on her right ankle for a brown recluse spider bite that looked horrible. Needless to say, she was unhappy with the bunionectomies I performed and I was sued along with my assistant surgeon and the resident on the case. She sued me for all the normal things of lack of informed consent, chronic pain, inability to have sex, unable to work, loss of future income, etc.
They had an economics guru expert from University of Houston to figure out her future loss of income. Their expert witness was a "Board certified foot and ankle orthopedic surgeon" from San Antonio who hated podiatrists. My expert was a board certified podiatrist from...
Editor's note: Dr. Zale's extended-length letter can be read here.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ken Hatch, DPM, Herb Schmirer, DPM
I did get a notice via my state association. I first joined APMA in 1976. I am now a life member. When I tried to vote, it kicked out my password and number. When I called APMA, I was told that LIFE membership did not include voting rights. WE old guys saw the best and worst of podiatric medicine over many years. I guess the current leadership does not need input from our experience.
Ken Hatch, DPM, Annapolis. MD
I join the growing list of APMA life members whose vote is not important to the APMA. If my opinion is not good enough for the APMA, my money will not be either.
Herb Schmirer, DPM (Retired), Port Washington, NY
Editor's note: This topic is now closed.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Bret Ribotsky, DPM, Lawrence A. Santi, DPM
I’m eagerly awaiting APMA’s response to this issue before I send my check. Please choose wisely.
Bret Ribotsky, DPM, Fort Lauderdale,, FL
APMA values every member and their input, and we apologize to any life member who may feel disenfranchised by the current referendum. As background, eligibility to vote in a referendum is codified in the APMA Bylaws for each member category—the APMA Board of Trustees and staff cannot simply choose to allow life members to vote. The Bylaws, Procedures, and Rules Committee reviewed the privileges afforded each member category as part of its comprehensive review of APMA’s governance documents and included the current privileges that were adopted by the 2019 House of Delegates. Life members are not the only category of members who are ineligible to vote. For more information on eligibility, check out our FAQs about the referendum at www.apma.org/referendum.
The philosophy of the committee has been that members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum. So, life members, who are retired from practice, would not be affected by language designed to support scope of practice modernization.
I have heard your concerns, and the Bylaws, Procedures, and Rules Committee will consider the feedback we have received from life members at its fall meeting. To be clear, changing the bylaws would require action by the APMA House of Delegates, so any changes will take time. I thank you in advance for your patience and understanding.
Lawrence A. Santi, DPM, President, APMA
Editor's note: This topic is now closed.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Steven J Berlin, DPM, Carl Solomon, DPM
I read that several retired podiatrists have felt slighted by not being able or being denied the opportunity to voice their opinions on current events affecting the profession. That certainly needs to change. I suggest a column of current situations affecting this great profession. We need a special column in the newsletter drafted by senior editors and/or Journal to encourage the opinions of us older podiatrists
Steven J Berlin, DPM
I acknowledge, but don't agree with the philosophy that life members are ineligible to vote because "... members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum."
That makes about as much sense as not allowing voting rights to members who are employed by a hospital or other institution, because they may not be affected by certain issues that would have a greater impact on private practice docs. Some issues affect everybody and some issues do not affect everybody. We cannot permit our membership to be fragmented like that.
Carl Solomon, DPM, Life Member, APMA
Editor's note: This topic is now closed.
08/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Ira Cohen, DPM
I join Rod, Larry, and Name Withheld in deciding not to pay the voluntary contribution after 39 years of practice and 4 years of Life Membership. I learned so much from senior DPMs like Sy Lane, Howard Marshall, and a long list of veteran podiatrists.
As California podiatrists, we fought for years to obtain ankle privileges (I believe 2nd in the nation) establishing a path for many states to follow. For APMA to take our contribution and not allow us to vote indicates they have no regard for our decades of experience in medicine and politics.
Ira Cohen, DPM, Boca Raton, FL
08/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Steven E Tager, DPM
I too am a life member of APMA. I also did not get solicited for my opinion on the APMA definition of podiatry. I will withhold my contribution this year.
Recalling something about "taxation without representation" comes to mind and who knows more about "history can teach us a lot" than those who lived it?
Steven E Tager, DPM, (Retired), Scottsdale, AZ
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
I am an APMA Life Member. I love APMA and its decisions most of the time, but not always. Not only can we not vote, but in the past, I have found that suggestions for specific positive actions that would benefit podiatry and our contribution to public health have been disregarded without explanation. One would think that new ideas and opportunities would be welcomed and respected and not treated with indifference.
Lawrence Rubin, DPM, Las Vegas, NV
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: APMA Member
I am a life member of APMA who was solicited for a $150 voluntary contribution. I did not get solicited for my opinion on the APMA definition of podiatry. I think I'll withhold my contribution this year just like the Life Member in the August 27, 2024 PM News. That's only two of us withholding and it won't make much difference in the APMA budget, but perhaps other Life Members who have not sent their contribution might follow suit and join us. What our action does do is alert the younger members of APMA what the future holds in store for them. Perhaps APMA could count 3 out of 5 Life Members in determining our input.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
RE: Who Decides Who is a Physician? (Rod Tomczak, DPM, MD, EdD)
From: Paul Kesselman, DPM
This is a very interesting topic considering that on this very day 47 years ago, I attended my first classes at what was then referred to as the Illinois College of Podiatric Medicine (ICPM) and which is now part of the Rosalind Franklin University (RFU). Almost fifty years later, ICPM has been incorporated into the "mainstream" medical educational system. For those who are unaware, RFU hosts the Chicago Medical School, Scholl College of Podiatric Medicine, School of Nursing, Pharmacy, and several other programs in the medical field.
During my undergraduate podiatry rotations, whether at the VA or Naval Hospitals, there was no distinction for medical (MD) vs. podiatry (DPM) vs. DO students. We all were treated in the same tough manner. Not once during those rotations did I ever hear, "Oh, you are a podiatry student; we don't expect you to ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Eric J. Lullove, DPM
There are numerous multilayer compression systems on the market for management and treatment of venous leg ulcers. They are not “replacements” of an Unna boot. They are specific for a different diagnosis code set. Multilayer compression systems should be billed with the I87.xxx series ICD-10s. The CPT code for those systems is 29581. The code is not a substitute for making a multi-layer compression from your supplies — this code was designed specifically for the compression system kits that are manufactured by 3M, Urgo, Milliken, Hartmann, et al.
You must document the need for edema control, CEAP or VCSS clinical documentation for a VLU or venous hypertension (or hyper congestion) as well as the failure of conservative therapy of elevation and stockings. You also should as a caveat have a recent ABI dated from the initial onset of the venous event or ulcer and any other additional vascular studies (venography, for example). As always, it’s about documentation, documentation, documentation, especially with wound care services.
Eric J. Lullove, DPM, Coconut Creek, FL
08/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Lawrence Rubin, DPM
"Medicare and private insurance cannot always identify an MD's or DO's specialty and their use of billing codes as easily as they can with a DPM after their name." - Reingold
In response to Dr. Reingold's post that suggests Medicare may not know what provider specialist such as DPM, MD, etc., is billing the claim, and that knowing this might alter a payment coverage, this is not the case. A Medicare/Medicaid Provider Number (MPN) on the claim verifies that a provider has been Medicare certified and establishes the type of care the specialist provider can perform. This identifier is a six-digit number. In addition, other than there being a few exceptions, Medicare considers podiatrists as physicians providing what it determines and publishes to be medically necessary for all specialties and is within the scope of our license.
Lawrence Rubin, DPM, Las Vegas, NV
08/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: APMA Wants My Money, Not My Vote
From: APMA Member
APMA excludes Life members from voting, then asks for money. I feel quite disappointed that the recent referendum about the new definition for podiatric physician that APMA is seeking approval for has excluded life members from voting. Who better than people who have longitudinal knowledge and experience to be able to shed insight into this process?
And then the same week, I receive a lifetime member contribution form with APMA asking for $150 from me. I have always paid this contribution amount to APMA, but this year I’m refraining from doing so because obviously if my vote doesn’t count, neither does my money.
APMA Member (Verified)
08/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jack Reingold, DPM
I graduated from CCPM in 1979 and retired in 2023, practicing in San Diego, CA the whole time. Luckily, there were hospitals in the area that let me have surgical privileges when I started. Within 15 years, all the hospitals in my area granted podiatrists virtually full surgical privileges (including ankle) and admitting privileges. Managed care arrived and discovered that podiatrists delivered excellent, cost-effective care and began hiring them in great numbers. Kaiser Permanente Medical Group went from none to currently 21!
Hospitalists started calling us and begging us to take patients. Nobody seemed to care about our degrees, caring only if we could take care of their patients (and perhaps off their hands). The hospitals wanted us to take positions on many...
Editor's note: Dr. Reingold's extended-length letter can be read here.
08/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatrists Should be Doing Their Compliance Due Diligence
From: Lawrence Rubin, DPM
Due diligence refers to the reasonable steps that should be taken by a person or business entity in order to satisfy legal requirements. This diligence should include complying with the Medicare Office of the Inspector General (OIG) strong recommendation to have a provider and staff written compliance plan that is implemented and kept up-to-date.
There is no better way to avoid unintentional coding and documentation errors from resulting in an audit that can lead to potentially devastating punitive actions. This is because the OIG is on record for saying: Having a provider and staff (including outsourced billing staff) compliance program can be a mitigating factor in the decision of whether or not we (OIG) effect punitive action.
If you are a solo or small group practice owner or manager and are interested in knowing more about Medicare compliance matters, discuss this with your healthcare attorney or a qualified compliance consultant.
Lawrence Rubin, DPM, Las Vegas, NV
08/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Steven Finer, DPM
After reading Dr. Tomczak’s post, I reviewed the various boards in Pennsylvania. The Podiatry Board is the only medical one that requires two physicians, save one other. Physical therapists, require one. I have not researched the history of these board hand holdings. Somewhere in our past, podiatrists needed a lot of guidance, lest they stumble and do something idiotic. It seems that chiropractors, optometrists, and dentists do not need any help.
Steven Finer, DPM, Philadelphia, PA
08/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Joel Lang, DPM
My heartiest congratulations to Dr. Michael and his "soon-to-be-doctor" daughter for not accepting the status quo. Nothing ever changes until someone decides to change it. Sometimes it only takes a small voice speaking into a receptive ear. If she were my daughter, I could not have been prouder. Jonathan, give her a hug from all of us.
Joel Lang, DPM (Retired) Cheverly, MD
08/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From Paul Kesselman, DPM
Orthotics are custom fabricated, custom fitted, off-the-shelf, etc. Some companies advertise their wares as being able to cure everything and custom fabricated. While not every consumer can sniff out the snake oil salesman as medical providers, it is our job to report those who violate the law! Each state has different board regulations on who can dispense orthotics. If a company is marketing custom fabricated or custom fitted orthotics to the consumer, there are often state laws limiting this activity.
One can identify the 20 or so states which strictly regulate who can provide orthotic devices. By visiting the NPE West contractor at NSC, one can search under tools bar for a particular state's licensure database for all sorts of DME. Here you can find your state's licensure requirements for dispensing all types of orthotic devices. If you find that you practice in a state requiring a licensure and should the orthotic manufacturer be marketing directly to the consumer, this may be a reportable violation of the state’s laws and must be reported. There may be different regulations between custom fit, off-the-shelf and custom fabricated orthotics. So one needs to be careful to check all three benefit categories (OR1 =Custom Fabricated, OR2=Custom Fitted; OR3=Off-the-Shelf).
It is important to note that while this information is available on a Medicare contractor's website, the NPE contractor is using your state's board information and this is updated on a fairly regular basis. Thus, it is both fairly reliable and accurate.
Paul Kesselman, DPM, Oceanside, NY
08/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jonathan Michael, DPM
I appreciate all the comments sent regarding my initial post. Here is an update to the situation: My daughter decided to have a meeting with the dean who happened to be fairly new to the school and went to a medical school with a podiatry program. She was very empathetic to the situation and told my daughter that the reason she was told "no" initially by the staff below her is that the rule was set from before she was dean at the school.
She encouraged my daughter to write a letter to the committee laying out reasons why podiatrists are physicians and surgeons. Following the detailed letter by my daughter, we got the news this morning that her wish was approved by the committee and I will (hopefully) coat my daughter at the end of the month at her medical school.
Jonathan Michael, DPM, Bayonne, NJ
08/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: False Advertising about Orthotics? (Vincent Gramuglia, DPM)
From Elliot Udell, DPM
Dr. Gramuglia brings up two issues. One is whether a non-medical professional can prescribe orthotics. The other is whether a provider, professional or non-professional, can promote their product as being a panacea for all sorts of non-pedal ailments.
Anyone can legally sell foot orthotics. We are all aware of the Dr. Scholls machines in Walmarts, and orthotics sold on the internet via Amazon as well as in all sporting goods stores.
Whether a vendor can make a claim that his or her orthotics can cure herniated discs, scoliosis, or other systemic ailments is a legal matter and most states have district attorneys who investigate fraudulent claims made by any vendor selling any sort of product. Perhaps Dr. Gramuglia should call his local DA's office and report the matter.
Elliot Udell, DPM, Hicksville, NY
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Robert Boudreau, DPM
When I entered private practice in 1984, I wanted to apply at one of our local hospitals for surgery privileges. I called and made an appointment with the chief of staff, a gruff old cardiothoracic surgeon. When I showed up, rather than meet in his office, he chose to hold our meeting in the cafeteria. After going over my credentials and residency training, he said, “I’m sure we can grant you privileges. I often have patients that need a good toenail trimming.” I tossed the application in the hospitals round file cabinet.
Fast forward to the late ‘80s, early ‘90s when PPOs and HMOs hit the scene. The hospital came begging for podiatrists to come to their ORs and do outpatient surgery. I applied for privileges and was granted every privilege I asked for. As my practice grew, I had less time to travel to that facility (a 30 minute drive from my office), and since I held privileges with 2 hospitals within a 5 minute walk from my office, I made the decision to give up the privileges at the distant hospital. I wrote a letter stating my intentions to the grumpy...
Editor's note: Dr. Boudreau's extended-length letter can be read here.
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Richard Haas, DPM
I have been in practice 44 years and can’t understand why the APMA has not been able to make podiatrists physicians in the eye of the law. I have seen pharmacists giving injections and physical therapists giving wound care freaking our profession out.
Being recognized as a physician should have always been the most important goal of the APMA, not worrying if we are MDP or PMD, etc. Who cares about that if we are not recognized as physicians. Where does our dues money go? DOs and dentists seem to know what to do with their money in regards to political action for their members.
Richard Haas, DPM, Temecula, CA
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Fay Sharit, DPM
Courses that meet this requirement can be found for free on pri-med.com.
Fay Sharit, DPM, Glen Rock, NJ
08/02/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
Jonathan, it’s a shame you can’t help your daughter put on her white coat for the first time in public, and, yes, I think it is a form of discrimination. For years, MDs looked down on DOs and still do, but it is much more subtle. They could always use the fact that DOs took the COMLEX licensing exams instead of USMLE and supposedly the COMLEX was easier to pass than USMLE. Now DOs can take USMLE so MDs don’t have the “we take a tougher licensing exam” platform to look down from. And, there are not enough MD graduates to fill all the residency slots in MD hospitals, so MD hospitals have generously condescended to accept DOs into their residency programs.
Don’t let the MDs kid you, there are huge economic incentives to suddenly treat DOs as academically equal to MDs, about a 100,000 reasons per resident per year. This becomes very important when rural hospitals are trying to keep the doors open and it doesn’t hurt big teaching...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: John Throckmorton, DPM
I find it interesting that the DO school which Dr. Michael’s daughter is attending won’t let him do the white coat ceremony for his daughter. I was allowed to do this for my daughter at the DO school in Michigan and also help the Dean give her diploma to her after her four years at the graduation ceremony. After being in practice 30+ years in the state, to be with our daughter, we moved to North Carolina
She was the first DO doctor to do the palliative fellowship at Vanderbilt and she was, at times, talked down to because of her DO degree. Professional degrees status varies in different states and around the world. I believe that Michigan’s DPM status is due to the fact we had the first residency in the country at Civic Hospital in the early 60s. I am hoping that the number of residencies continues to grow in the states where we lag behind in them, and through interaction with not only our colleagues, but other health professionals, i.e. MDs, DOs, and other recognized providers.
John Throckmorton, DPM, Moorseville, NC
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jose Aponte, DPM
I am sorry to hear that your daughter was denied the privilege of your being able to put the white coat on her future White Coat Ceremony at her present school of osteopathy. In my opinion, this sends the wrong message to the new students. Recently, I attended my son's WCC at a medical school and was allowed to put the white coat on his shoulders without any controversy.
As I understand, the WCC was designed by The Arnold P. Gold Foundation. I would contact this foundation and let them know your situation. Maybe they have a position that you can present to the osteopathic school your daughter is attending and hopefully help change their thoughts about all this. Regardless of the outcome of this situation, your daughter should be very proud of you for being a DPM.
Jose Aponte, DPM, Caguas, PR
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