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02/29/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: David Secord, DPM
One aspect of the current surfeit of schools of podiatric medicine we should consider is how an average applicant pool being diluted by so many schools weakens the whole. I can only speak of Temple, as I am good friends with someone who instructs there and reveals that the number of applicants and the number of admitted students is too low to sustain a tuition-driven institution.
I understand that at some point Temple University dropped the hammer and let the school of podiatry know that it has to start being a neutral entity and not be financially subsidized to keep it afloat. I know of no established time frame, but if Temple may be contemplating the long-term fate of the Philadelphia school (my alma mater) I can only imagine that...
Editor's note: Dr. Secord's extended-length letter can be read here.
Other messages in this thread:
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Elliot Udell, DPM
Kudos to Dr. Ribotsky for suggesting that there be some way of tracking podiatrists diagnosed with some form of cancer. As a cancer patient in remission, this issue is very close to me.
The medical community is grappling with another issue. Patients with breast and colon cancer are now presenting at very young ages. One patient of mine had his first colonoscopy at age forty and discovered that he had stage four colon cancer. Another young woman in her thirties is undergoing treatment for breast cancer. Are these caused by unidentified carcinogens or are people discovering these conditions earlier in life because of testing and awareness?
Elliot Udell, DPM, Hicksville, NY
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
05/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Kornfeld, DPM
Since this thread is still going, I would like to bring up a really important point that Dr. Meisler glossed over. Patients coming from these concierge practices were willing to pay directly when they came and were "surprised that they did not have to pay at the time of their visit." That should tell you something about the value they are experiencing in a direct-pay practice. That's number one.
Number 2, I agree with Dr. Meisler that eliminating poor payors will always make room for more value in the practice. However, it is important to note that as long as you continue to accept insurance, you will always be fighting an uphill battle. You will need to see a high volume of patients which means a large office, large staff, and high expenses. You will still have to navigate the slippery slope of...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
04/12/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Greg Caringi, DPM
Salus University, the former Pennsylvania College of Optometry, now has a certified Orthotics & Prosthetics program. Has our profession completely abandoned a science and a skill that distinguished us from other health providers?
Greg Caringi, DPM, North Wales, PA
04/11/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Sarah B Clark, MS
I have been using Freshbooks for nearly 5 years and have been very pleased with it. They have an extension for check writing that integrates seamlessly, as well as payroll options. There are a variety of plan levels depending on needs and budget. It is web-based and there is an app for your phone as well, and all updates are done without extra fees.
Sarah B Clark, MS, Charlotte, NC
03/13/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Michael A Uro, DPM
Thank you Dr. Tomczak for the gracious compliment. The feeling is mutual. Once again, I agree with your assessment of our profession. While I do not possess your eloquence in the written word, I will in my own humble way attempt to further express my feelings. Your assumption as to why I would not recommend podiatry to a college student is correct. I do not like the direction in which the profession is going.
Not everyone who enters medical school wants to be a surgeon. Not all have the abilities to become a surgeon. Does this make them any less of a physician? Of course not. Our patients need and deserve the experience of all the specialties and subspecialties. It takes many spokes to...
Editor's note: Dr. Uro's extended-length can be read here.
03/12/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Lawrence Oloff, DPM
Let me start off by saying I am happy with my chosen profession. I have read the posts over the years about the profession and its frustrations. As a side note, I wish such discussions did not surface on public forums as I fear that this likely has had a negative impact on student recruitment, but I guess that is the way of the world in an era of social media. Why we should be happy with our chosen profession is a complex discussion and probably needs two parts. Here is Part 1.
What I find interesting is that people think that these claims of unhappiness, discord, frustration, the haves and have nots is unique to podiatry. I can assure you it is not. I have had many podiatry lives: Dean of a podiatry school, practice in an orthopedic group who managed professional sports teams, large institutional medicine, and as the first podiatrist in the orthopedic department at Stanford with an...
Editor's note: Dr. Oloff's extended-length letter can be read here.
03/07/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Allen Jacobs, DPM
Waiting for Godot? Vladimir and Estragon waited and waited. As you know full well Dr. Tomzack, Godot never arrives. The play was an offering of the theatre of the absurd. Is this the arena in which we as a profession now function? Yes there are “haves and have nots”. The Joshua tree you refer to (actually a plant and not a tree) has branches which include rather complex surgical interventions performed by some podiatrists. Charcot joint reconstructions, deformity corrections with external fixation, distal leg and ankle trauma management are a long way from the DSC days you fondly recall.
Our first responsibility is to protect the public and assure that those providing advanced care with significant responsibilities possess adequate training and experience. To a large extent, DPMs are entrusted with the authority to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Dominic Bianco
Public knowledge and educating the public is really part of the answer. The other part is the patient has to feel confident and comfortable with their choice when seeking medical attention.
Retailers are now selling custom-made orthotics utilizing shippable impression kits. These start at $200. Originally, they were only available through podiatrists who were selling to their patients custom orthotics for $200 back in the 1980s. Now it seems these products are widespread, not just in custom orthotics but for all kinds of podiatry products.
Podiatrists, on average, are seeing 10-20 patients per day. Overseeing their practice and growing it takes a lot of...
Editor's note: Dominic Bianco's extended-length letter can be read here.
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
01/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Gian Steinhauser, DPM
I’ve used Stryker Smart Toe implants for over a decade and had no issue with them with MRI in the past. Stryker Smart Toe implants are made of memometal nitinol, an alloy made approximately of 50% nickel and 50% titanium. Nitinol, a nickel-titanium alloy, is generally considered safe for magnetic resonance imaging (MRI). Nitinol is non-ferromagnetic, meaning it doesn't dislodge during an MRI and only heats slightly. It's considered safe for MRI. The metal typically will show a bit of image flare around the implant site on MRI imaging, so as long as you’re not interested in seeing tissue directly adjacent to the implant, it should be fine.
Gian Steinhauser, DPM, Houston, TX
01/12/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Steven Kravitz, DPM
Dr. Jacobs’ post to pay tribute to Dr. James Ganley is an absolute pleasure to read. Thank you Dr. Jacobs for taking the time to articulate this and to Dr. Block for publishing and helping it gain some traction and attention, so that many have the ability to read it. There are a lot of lessons in it, and Dr. Jacobs' beautifully touches the surface describing attributes, nuances, and the ability to get to feel who Dr. Ganley was, and why he is recognized as an icon. Humble with humility, brilliant, without exception compassionate for others, a sense of balance in life, and ability to enjoy other aspects outside of his profession... sailing being just one of them.
One important point that comes out as you read the tribute is how much Dr. Ganley appreciated and enjoyed being a podiatrist. There's too much negativity today about our profession and...
Editor's note: Dr. Kravitz's extended-length letter can be read here.
11/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Howard Bonenberger, DPM
I worked with Mike Crosby for evaluation, pricing, and negotiation of the terms of the sale of my solo practice in 2017. I found him to be a great resource. At a minimum, a 5-year look back at financials should be performed. I would avoid the low-priced consultants. You could leave a lot of money on the table.
There is much more to it than you can imagine. Find a highly regarded medical practice business attorney (not malpractice). Your CPA should also be involved if they are qualified in this arena and may be able to recommend an attorney to interview.
Howard Bonenberger, DPM (retired), Hollis, NH
11/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Richard M. Cowin, DPM
For a practice valuation, I highly recommend Mr. David Price at Podiatry Broker. He offers three (3) levels of service for three (3) different prices: $395.00 for a ballpark evaluation, $995 for an off-site evaluation, and $3,995 for an on-site evaluation.
Richard M. Cowin, DPM, Orlando. FL
10/27/2023
RESPONSES/COMMENTS (NON-CLINICAL)
From: David Laurino, DPM
I was thrilled to see your inquiry about the potential role of virtual assistants in podiatry practices. Having been deeply involved in the field, I see tremendous potential in integrating these technologies and individuals especially in our current workforce and the difficulties that all practices have had trying to find quality individuals to help our clinics. Here are just a few of the tasks that VAs can do for our clinics:
1. Streamlined Appointments: A virtual assistant can help manage appointments efficiently, sending reminders to patients, rescheduling when necessary, and thereby reducing no-shows.
2. Patient Queries: Many a time, patients have simple queries past their visit. Virtual assistants can handle these routine questions, freeing up our medical staff for more...
Editor's note: Dr. Laurino's extended-length letter can be read here.
10/11/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: John Cozzarelli, DPM
Dr. Jacobs' comments on Krystexxa's FDA indication are not accurate. He references that it is indicated for the treatment of hyperuricemia.
Direct from the Patient Package Insert "INDICATIONS AND USAGE KRYSTEXXA® (pegloticase) is indicated, for the treatment of chronic gout in adult patients refractory to conventional therapy. Gout refractory to conventional therapy occurs in patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.
Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia."
John Cozzarelli, DPM, Belleville, NJ
09/18/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Brian Kiel, DPM
I have two simple remarks in regard to recent issues in our profession. Firstly, CPME and AMPA may well be “separate” entities, but if you believe that, then I have a bridge to sell you over the Mississippi River. Secondly, there is letter after letter bemoaning the fact that we have given up routine foot care, but you have to have a 3-year surgical residency to practice. Does that not seem convoluted to you? Just a thought.
Brian Kiel, DPM, Memphis, TN
09/15/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Richard M. Maleski, DPM, RPh
I'm somewhat confused by the responses to this topic. I retired a few years ago, but I believe my information is current. In Pennsylvania, podiatrists are prohibited from using ancillary personnel to cut nails or calluses. Podiatrists must perform those services themselves, otherwise they are committing insurance fraud (if sent in to insurance.) Admittedly, this took place years ago, but in 2008, I spoke with the PPMA about training my certified podiatric assistant to cut nails and calluses, and was told that this was fraudulent if sent in to a third party payer, (billing for services that I wasn't providing) and allowing a person to perform services that I was not legally entitled or licensed to supervise.
I was seeing 40-50 patients daily 4 days per week at that time, and typically on any given day about 1/2 to 2/3 were "routine care." I was giving up new patients because...
Editor's note: Dr. Maleski's extended-length letter can be read here.
09/14/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Ivar E. Roth DPM, MPH
I have been offering routine foot care since I began practicing 38 years ago after completing a 3 year surgical residency program. Lately, and I am not sure why, there has been a huge increase in new patient calls for routine care. I am averaging 4 new patients a day who just want their nails and calluses trimmed. Today again, I had one of those patients request that I make her orthotics after I explained why they would help her. Believe me, routine care is bringing in lots of pathology to my office. Two others wanted to have treatments for their fungus nails. While it has taken years to develop this following, I think that the other podiatrists in town have abandoned this care, and I am now thankfully the recipient.
Lastly, I call my extended care nail techs “podiacurists” as they all are former pedicurists converted to medical nail techs/podiacurists who I have trained to do nails and callus care. I sincerely hope that any podiatrist who want to get busier get the word out that you do routine care; you will not regret that decision.
Ivar E. Roth DPM, MPH, Newport Beach, CA
09/08/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Ivar E. Roth, DPM, MPH
I would like to inform those not taking routine care patients that they are missing the boat. I give a full examination when routine care patients enter my office. I consider this a service to them and advise them of all the areas of concern that I observe, and inform them of their conditions that need attention. The majority of these routine care patients need some other services. I only inform; no pressure or sales tactics are used. I let the patient tell me if they desire further care.
Since most of these patients never had any professional take the time to inform and explain to them what they need or did not know, many opt to have the services that I explain are available. For instance, I just had a C and C patient come in and decide they want their fungus nails treated and get a pair of orthotics. That patient who came in for a $125 service left paying $3,525.
As a direct care doctor that extra effort I spent on them both helped them with their medical issues that they had no idea that they had, and it reimbursed me very nicely for their care.
Ivar E. Roth, DPM, MPH, Newport Beach, CA.
09/06/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Elliot Udell, DPM
Dr. Rubin is dead on target when he questions whether podiatrists trained in foot surgery are no longer addressing non-surgical foot problems. This discussion is linked to the ongoing discussion on nurses who are starting foot care clinics. As a profession, we are like ostriches with our heads buried in the sand; we don't want to see that other non-doctoral level professions can and will encroach on all facets of foot care. Those who feel that their professions are secure because they only do surgery have their heads buried deeper in the sand.
In my local hospital, PAs working in the operating room have told me that the general surgeons often allow them to do procedures "skin to skin." It is a matter of training and we could see future clinics run by physician assistants, trained by orthopedists and podiatrists, delivering high levels of foot care without the need of a podiatrist. It's only a matter of time until this happens. We have had many discussions over the years about non-podiatrists casting for and dispensing orthotics. It hit home when I witnessed my own physical therapist taking impressions for and ordering orthotics for his patient and the order was placed at a lab that promotes itself to our profession. What is the solution? Until there are legal statutes put into place, we simply have to love and be good at taking care of feet, and happy patients will refer others to podiatrists for foot and ankle care.
Elliot Udell, DPM, Hicksville, NY
09/06/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Allen Jacobs, DPM
Dr. Rubin notes that podiatrists, in deference to alternative healthcare providers, maintain the ability to provide "optimal preventive and therapeutic foot-care". Optimal care is more than selling diabetic shoes and toenail reduction. It is evaluation and treatment of or referral for treatment of neuropathy, vascular disease, dermatological disorders, gait abnormalities, and off-loading of areas predisposed to ulceration. It is active treatment of onychomycosis. The question you must ask yourself is whether or not you do indeed provide “optimal care" .
Allen Jacobs, DPM, St. Louis, MO
08/30/2023
RESPONSES/COMMENTS (NON-CLINICAL)
From: Neil Campbell, DPM
There was a point in my professional career when I could not have agreed more with the positions of Dr. Davis, et al. For the vast majority of podiatrists who are trying to protect and grow their practice and raise a family, it is perfectly reasonable to ask the questions that have been posed previously. Then I got involved with my state association and the vast depth of my ignorance quickly became apparent to me. It did not take long to realize that without APMA and the state associations, there would simply not be a podiatric profession.
The incredible amount of work that is done by a small group of paid staffers and a very small group of extremely dedicated podiatrists who volunteer their time and treasure – at a cost to their practices and families, is awe-inspiring. In Texas, people like Drs. Paul Kinberg and Leslie Campbell have worked for decades to keep podiatry from being destroyed by a variety of regulatory and legislative initiatives. Those on the outside complain about what our leaders have not done, when the vast amount of the time we are just fighting to keep the really bad things from happening.
“Somebodyelseism” is certainly attractive and easy, but it is very destructive. The limitations of our profession and frustrations elucidated in this forum are real. The answer is to get involved in being part of the solution. Join a committee, visit with and donate to your local legislative representative. Or do not. Then we can all watch podiatric medicine die slowly, and then wonder why it seemed to die all at once.
Neil Campbell, DPM, Cuero, TX
08/28/2023
RESPONSES/COMMENTS (NON-CLINICAL)
From: Marlene Reid, DPM
I want to thank Dr. Chris Seuferling and the Oregon Medical Board for acknowledging the Federation of Podiatric Medical Boards (FPMB) and especially recognizing Russ Stoner, its Executive Director. The FPMB serves as the national voice for state podiatric medical boards while collaborating with allied organizations, supporting member boards with services and initiatives that protect and promote patient safety, integrity of podiatric medicine, access to high-quality healthcare, and regulatory best practices. Over 40 state boards pay voluntary dues to support the function of the FPMB. Oregon is just one state that has recently benefited from the services of the FPMB and Mr. Stoner's commitment.
As Dr. Seuferling pointed out, Executive Director Russell Stoner goes above and beyond to assist state licensing boards with data collection and computation of information to empower and assist state boards in their...
Editor's note: Dr. Reid's extended-length letter can be read here.
08/15/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Khurram Khan, DPM
To piggy back on Dr. Pressman’s post: When listening for Doppler sounds, pay attention to the difference in quality of the sounds from all 3 vessels. In this article we recently published, we employed a modified lower-extremity Allen test to demonstrate an irregularity in vascular perfusion in the foot after a difference in pitch between the dorsalis pedis artery and the posterior tibial artery was heard using a hand-held Doppler.
Khurram Khan, DPM, Clinical Associate Prof, TUSPM
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