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12/13/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Paul Kesselman, DPM, Mark Spier, DPM
The whole point of my last letter was to point out that we, as individuals, are partly if not totally responsible for setting our own self-worth. If we don't, who will? If we podiatrists, as Dr. Secord states, are allopathic physicians, then it’s time we start acting like ones.
Can you find me an MD or DO who will work for the kind of dollars DPMs line up and stab each other in the back to sign up for? And that is the crux of the problem. We think if we sign up for less, then we can become invaluable to the patient and carrier. In fact, that’s exactly the opposite of what happens. The carrier realizes we are so dependent on them, we become so desperate to retain their lifeline, that they pay us less and less. So who’s really responsible for this? Each of us!
Paul Kesselman, DPM, Oceanside, NY
I’m asking if the antipathetic allusion to allopathy is an anonymously announced alliterative allegory? Or is it not necessarily nuanced enough to notice now?
Mark Spier, DPM, Reisterstown, MD
Other messages in this thread:
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2B
From: Robert D Teitelbaum, DPM
David Secord's posting recently about "allopathic" medicine and how DPMs are allopathic doctors was a great lesson in the real meaning and the corruption of common words that we use to describe our professional status. I would also like to bring up three words that have held us back professionally and consistently for 40 years and I have not seen them much talked about. Those three words are Routine Foot Care.
My thesis is this:
1.There is no complaint about foot pain that is routine. A patient who realizes that her bent second toe has a painful corn on the first joint that hurts in all shoes is in distress. They need someone to counsel them on the choices they may face and the treatments that are relevant. The patient wants our experience, knowledge, and ability to communicate. They want a plan of action--in other words they want...
Editor's note: Dr. Teitelbaum's extended-length letter can be read here
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2A
From: Robert Kornfeld, DPM
Dr. Kesselman makes a powerful point. But it isn’t limited to DPMs as to under-valuing services. I am friends with many MDs and the ones who still accept insurance suffer the same issue. The system has conditioned patients to not want to pay for anything so doctors feel their services have no value. I used to share an office with a cosmetic dermatologist and a plastic surgeon. They collected enormous amounts of money every day from their patients, and my patients often refused to pay co-pays and deductibles.
I went to a direct-pay model almost 24 years ago. I decide what my services are worth. I set my own fees. Every patient pays my full fee at the time of the visit. My accounts receivable has been $0 all these years. And I have made almost double the net income on 8-10 patients daily than I made on 50 insurance patients daily. Honestly, it’s a choice. I do not work hard. My days are pleasant and stress free. No one has to be exploited and abused by insurance companies.
Robert Kornfeld, DPM, NY, NY
11/30/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Gary Rothenberg, DPM
I would like to applaud Luke Hunter and Amanda Miller for their recent article posted from Podiatry Management. As a podiatrist who has a career dedicated to prevention of lower extremity complications among people with diabetes, any opportunity to share thoughts on the significant relationship between mental health and diabetes outcomes is welcome. However, I ask that we take this article to the next level and realize that language and words matter.
A lot of work has been done in the diabetes education space around the importance of appropriate and acceptable language in treating patients with diabetes. By the title of the article and even though people with diabetes are a significant part of podiatric practices, our field is slow to catch on to the significance of the words we use. "Diabetic" is a label and should be avoided when referring to people with diabetes. "Compliance" is authoritative and stigmatizing. There are excellent references that can help us all communicate in a more sensitive and effective way, especially important for our patients with diabetes and concomitant mental health issues. Robin Sharma said, ‘‘Words can inspire. And words can destroy. Choose yours well."
Lewis DM. Language Matters in Diabetes and in Diabetes Science and Research. J Diabetes Sci Technol. 2022 Jul;16(4):1057-1058.
Speight J, et al. Our language matters: improving communication with and about people with diabetes. Diabetes Res Clin Pract. 2021; 173.
Dickinson J, et al. The use of language in diabetes care and education. Diabetes Care, 2017; 40(12): 1790-1799.
Gary Rothenberg, DPM, Ann Arbor, MI
12/02/2022
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Kenneth Jacoby, DPM
The letter by Dr. Kesselman was well written but a sad commentary on today’s situation. What are the APMA and other organizations doing about this sad situation? And this goes further than diabetic shoes. When I went into medicine 37 years ago, it was patient first, which still holds true, but there are more hoops required to get compensated.
Kenneth Jacoby, DPM, Elgin, IL
10/05/2022
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Vuncent Gramuglia, DPM
The knowledge of biomechanics and its application in our evaluation and management of podiatric pathology particularly with regard to elective foot and ankle surgery is essential. Unfortunately, current understanding of the relationships between the forefoot and rearfoot are sometimes like visiting the Wizard of Oz. Does equinus cause pronation or does medial column instability result in Achilles contracture in an attempt to stabilize the medial column during mid-stance? The proper function of the peroneus longus and posterior tibial tendon may be more important than obsessing over the amount of eversion of the calcaneus which is very often neutral to slightly inverted.
The efficiency of the 1st MPJ and stability of the medial column described by Shavelson as the “kickstand of the foot” is a very interesting commentary on where to focus your attention when you are performing surgery or prescribing orthotics. This fresh perspective, I believe, may serve as a simple way to view the foot/ankle biomechanically and to improve our surgical decision-making; thereby making outcomes more predictable and successful.
Vincent Gramuglia, DPM, Bronx, NY
09/16/2022
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Elliot Udell, DPM
The argument as to why many insurance companies do not pay for orthotics is an old one. Dr. Roth may have hit on the reason when he writes that he tells his son, a podiatry student, that when he graduates, he should forget all that he learned in biomechanics and subscribe exclusively to Dr. Glaser's theory.
There are so many great biomechanics sages in our profession. There was Root, Weed, Orion, Schuster, Langer, and currently Shavelson, Glaser, and others. The list goes on and on. The never-ending problem is that all of these wise doctors' theories differ from each other. Hearing their lectures made believers out of the listeners, but insurance companies looking over their shoulders see conflicting theories and there is little evidence-based medicine to prove one theory from another.
The solution is for our labs to do what drug companies do. Invest in research, publish the research, and only then can the APMA and others go to Medicare and other insurance companies with credible reasons why patients should be entitled to be covered for their orthotics. We know that our patients feel better with orthotics, but that alone doesn't cut the mustard in the world of insurance.
Elliot Udell, DPM, Hicksville, NY
09/15/2022
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Ivar Roth, DPM, MPH
I would like to help Jeff Root understand what Dr. Shavelson meant. First, Dr. Root did give us the “language” which is still useful today but more in a historical perspective.
I have spoken to Dr. Shavelson in the past and I understand where he is coming from and I will try to interpret with my own twist his and my understandings. While Dr. Shavelson and I may disagree on what to call his biomechanical theory, I believe he is RIGHT ON. I subscribe to the MASS theory of orthotic lingo as opined by Dr. Ed Glaser. For those of you unfamiliar with Dr. Glaser’s theory, I would highly recommend that you...
Editor's note: Dr. Roth's extended-length letter can be read here.
02/18/2020
RESPONSES/COMMENTS (PM ARTICLES) - PART 2B
From: David E. Gurvis, DPM
There is room for all of us in all of our capacities. Some will make it as surgeons. I know several groups who will not do routine care, or biomechanics, or dermatology, etc. and some will morph into more generalists and still earn a great living and be just as satisfied. I do many surgical procedures and I do them well. I am limited in my training and send the complicated stuff out to the surgical groups.
My comments are regarding surgical vs. conservative care. Maybe because of finances, or training, it seems many of the surgeons no longer offer any...
Editor's note: Dr. Gurvis' extended-length letter can be read here.
02/18/2020
RESPONSES/COMMENTS (PM ARTICLES) - PART 2A
From: Alan Sherman, DPM
Why am I not surprised that in 40 years, none of Dr. Jacobs’ residents have told him that primary care practice is their first choice, despite 25% of residents telling us in our polling that they intend to be general practice podiatrists? That is precisely the reason that I conducted an anonymous poll where residents could give us honest answers. A resident would never, ever reveal this perceived “failure” to Dr. Jacobs. He is apparently among the residency directors who think that the more surgery a resident does, the more accomplished s/he is as a human being.
The poll data is not “alleged” or in dispute because Dr. Jacobs says it is. I’d like to dispel another assertion that Dr. Jacob naturally falls into in his comments – that this is a question of surgical vs. non-surgical podiatrists. It never was. All podiatrists do some surgery. This is a question as to how much they do. I prefer to represent it as advanced foot and ankle surgeon vs. general practice podiatrist. As this issue continues to be defined by podiatrists across the country, I would advise all to beware of those like Dr. Jacobs using the term primary care practice or non-surgical podiatrist. No one, least of all me, wants to take surgery away from any podiatrist. I simply want to direct our residency and other training resources to train all podiatrists in the skills that they will be using in practice.
Alan Sherman, DPM, Boca Raton, FL
02/14/2020
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Ty Hussain, DPM
The article written by Dr. Sherman is a point-making introduction to our continued education in our residencies. This is something that I have been talking with residents and others alike for the past 5-7 years. Regardless of numbers and percentages, we as a profession have evolved significantly with surgery at our helm and reaching as far as above the ankle as we could. I am involved with multiple residency programs at our local facilities and can evaluate residents and their comfort level in the surgical atmosphere.
I agree with most residents that the inclination to be great surgeons is enthusiastic in the beginning, but as time goes on, the lack of surgical cases leads to the question, "how much surgery do I need to be doing?" Our training of residents and the demand to have a 3-year program to have parity with our MD colleagues are actually not productive. I have discussed the possibility of podiatric medicine and surgery needing only a 2-year residency which will encompass rotations and podiatric medicine along with surgery. But those who wish to specialize in surgery can then proceed to attend a fellowship program which will enhance their strengths in being a podiatric surgeon, which by the way, will actually define the fellowship programs going forward. Those who wish to be in general podiatric care have had some surgical experience. Just going through motions to finish a program is not defining our existence.
Ty Hussain, DPM, Evanston, IL
09/16/2017
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Steven J. Kavros, DPM
I am writing to clarify the misrepresentation and inaccuracies of James McGuire, DPM in a recent article in Podiatry Management.
The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in clinician advocacy and education for the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting...
Editor's note: Dr. Kavros' extended-length letter can be read here.
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