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08/13/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Vincent Gramuglia, DPM
I am happy that Dr. Rubin brought up this false advertising regarding orthotics. If you ever listen to The PGA station with Michael Breed in the morning on Sirius radio you will have heard the Pine Valley orthotic commercial. I cannot express more emphatically how this ad ruins my day. Owner and “Inventor” Stu Sachowitz even features Michael Breed, who is usually a very measured and thoughtful broadcaster/golf instructor, on the Pine Valley bandwagon. These $99 over-the-counter inserts have the magical power to cure everything from plantar fasciitis to scoliosis and herniated discs. And by the way, they will Instantly cut your handicap In half. Stu says that if he can’t help you, he will gladly refund your $99.
He doesn’t care what size your feet are, whether they are flexible or rigid, pes planus, cavus, vertical talus, club foot... his “orthotics will correct the problem and make you a better golfer!” I don’t understand how companies like this are able to get away with these claims. Is this practicing medicine without a license? Did anyone in Pine Valley wonder if the lower extremity pain could be due to peripheral vascular disease or if the back pain was due to a spinal deformity or neoplasm? These miraculous claims are made without any evidence-based reasoning and are an insult to those of us who base our treatments on a sound history and physical and a knowledge of podiatric biomechanics. I’m sure that if a licensed healthcare provider made such claims, they might at minimum receive a phone call from their state society, or even visit from their medical board.
Vincent Gramuglia, DPM, Bronx, NY
Other messages in this thread:
08/24/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Name Withheld
Early this morning, I had just finished my coffee and reading the latest PM News. Once again, we, as podiatrists, were discussing the DPM vs. MD/DO parity issue and whether or not we are physicians. As usual, many in our profession believe we are on par with the MD/DO group and should be treated as such by all, and the other side believes we should remain as we are, our own profession.
I have to admit that there had been many times in my now 35 plus year career as a podiatrist that I have wished that I had gone the MD or DO route so I could be a “real doctor, a physician” but that had not been my path. I was daydreaming about what it would be like to be that “real doctor” and contemplating a second cup of coffee but my cell phone rang. It was a hospitalist standing in the ED at the local community hospital asking me to...
Editor's note: Name Withheld's extended-length letter can be read here.
08/20/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The Language of Podiatry
From: Lawrence Rubin, DPM
I rarely look into my storage boxes, but I did dust this item off when I found it sticking out of a box. I opened this notebook containing my first healthcare entrepreneurial venture. In 1978, with the help of Dr. Phil Brachman and a few other supportive faculty members of the Illinois College of Podiatric Medicine (now the Scholl College of Podiatric Medicine), I recorded and we published The Language of Podiatry tape cassettes and printed manual for podiatric assistants.
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The Language of Podiatry |
It made only a little money for me and the college, but it was very well received by many podiatric assistants. I'm wondering if any of my peers who might have bought this for their assistants is reading this post and remember it?
Lawrence Rubin, DPM, Las Vegas, NV
08/19/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM
The Merriam Webster Dictionary defines physician as follows: "a healthcare professional (such as a dermatologist, internist, pediatrician, or urologist) who has earned a medical degree, is clinically experienced, and is licensed to practice medicine as usually distinguished from surgery..."
What’s interesting is that two dictionaries distinguish "being a physician" from being a surgeon. In England, if a doctor specializes in surgery, he or she is no longer called doctor, but Mr. or Ms.
But who really defines who is a physician? It’s the patient! Many years ago, I needed to do an emergency incision and drainage on a patient who had a badly infected toe. He would not let me touch him until his chiropractor gave him clearance. He did not clear him and the patient eventually wound up in the hospital on IV antibiotics. In this case, who would that patient define as being his physician, I the podiatrist, his chiropractor, or the doctors who took care of him in the hospital?
Elliot Udell, DPM, Hicksville, NY
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
08/17/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Who Decides Who is a Physician?
From: Rod Tomczak, DPM, MD, EdD
So, are we or are we not physicians and who decides the answer? Does someone in an ivory tower get to ratify our decisions and are there legal repercussions if we answer in the affirmative? But another group asserts we made the wrong choice. Is there some knight in the background counselling us to, “Choose wisely!”
Chiropractors call themselves chiropractic physicians in several states, perhaps over 30. It seems ludicrous to think there are chiropractic physicians and not podiatric physicians, but yet here we are, and it is happening. How can this be? I think the problem begins with which medical board holds sway over a certain discipline. Every state has a chiropractic board that more or less governs chiropractors within the framework of the state law. Where ambiguities exist, the state legislature and attorney general turn to the...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
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
08/12/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: False Advertising about Orthotics?
From: Lawrence Rubin, DPM
Take this example of easy public access to ostensibly therapeutic orthotics. Will Internet purchasers be told to first make sure they see a podiatrist to rule out acute extra-articular rheumatoid arthritis plantar fasciitis as the cause of their sudden heel pain, not structural or functional foot pathology?
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Pine Valley Orthotics |
Maybe APMA agrees and will ponder giving the public the benefit of this potential public health alert initiative when it is called for.
Lawrence Rubin, DPM, Las Vegas, NV
08/07/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Benjamin J. Wallner
We want to thank Dr. Haas for bringing this issue up in PM News. APMA places the highest degree of priority on ensuring that doctors of podiatric medicine can practice to the full extent of their education and training to best serve the public health. We appreciate the opportunity to provide a brief a look back at our early efforts to promote, protect, and defend the profession, and to take a moment to highlight a few of our current initiatives.
Back in the 1960s, the American Podiatry Association (predecessor to APMA) successfully lobbied the United States Congress to define podiatrists as physicians under the Social Security statute which governs Medicare. This is the reason podiatrists have enjoyed the benefits (double-edged sword that it is) of being able to participate, and be reimbursed, as physicians under Medicare since the...
Editor's note: Mr. Wallner'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 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 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
08/05/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
I would sit down with the administration and point out rather graphically how the DO profession did find themselves in the exact same position years ago. And in fact, they are still facing the exact same discrimination. I have several close friends who went through the same sort of "hazing" many podiatrists went through, until it eventually stopped because we were able to prove our knowledge base in our area of expertise was at least equal if not superior to those "real doctors”.
You might even have some conversations with the AOA who has had a more cordial relationship with APMA than AMA. Certainly as was mentioned, the DO schools which have relationships with DPM schools might also help and be willing to intercede. But I have a further comment that goes beyond the professional issues. It is the parent who has given so much to get their child into the position of being "coated". To me, taking that opportunity away is a far greater form of disrespect to the parent than this professional prejudice.
I remember my WCC at ICPM more than forty years ago and it was the parent not some stranger who was given the honor to White Coat their child. This is the ultimate form of disrespect to a parent.
Paul Kesselman, DPM, Oceanside, NY
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.
08/02/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Robert A. Dale, DPM
I am responding to the question from Dr. Carlson about where to obtain cantharone. There is a compounding pharmacy in West Virginia I get that medication from. They make cantharone and cantharone plus which has an acid mixed with cantharone. The contact information for them is: Med A Save Pharmacy, 818 S Mineral St., Keyser, WV 26727.
Robert A. Dale, DPM, Clarksburg, WV
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Stephen Musser, DPM
I disagree with your daughter's school decision. If the state where her school is located includes podiatry in the definition as a physician, then I think you or your daughter can argue/refute the administration's decision. I once had an MD/DO point out to me that I shouldn't be parking in a physician designated parking spot. I politely told him I am considered a physician in the eyes of the Ohio medical board and left my car where I parked it. Nothing came of it and nothing more was said.
Stephen Musser, DPM, Cleveland, OH
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
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
07/31/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Amol Saxena, DPM, MPH, Jeff Carnett, DPM
It saddens me to read your post. The agenda of the AMA is to limit those who can be called physicians and surgeons to only those who are MDs or DOs, so it does not surprise me. I couldn't imagine that prejudice against me when my daughter was going through medical school. In fact, during a case on an orthopedic rotation, the resident said something to that effect to her. The attending had him call her to apologize. She graduates from orthopedic residency next year and her attendings have asked me to present grand rounds.
I think one option is to have your daughter transfer as this bias will not change. I discuss these biases in my lecture that is on PRESENT. This a good example of why we need our DPM schools to evolve to granting the MD degree. Sending empathy to you and your family from CA.
Amol Saxena, DPM, MPH, Palo Alto, CA
It is sad to read about this unnecessary discrimination against a DO student family. I know the Des Moines University DO college did a similar thing in 1984 when a son of a local DPM was not allowed to hood his son at DO graduation. The DPM had provided a free podiatry clinic to the DO school for 20 years leading up to this slap in the face. At the time, a nurse was allowed to hood her son at graduation, just to make the hurt even more. The College of Podiatric Medicine & Surgery at DMU was just starting at that time so the CPME was interested to hear about this and apparently did express concerns. If your daughter's school is at a university having a DPM program perhaps this could be something CPME might have some interest in.
The event was emotionally traumatic to the involved family. The DPM refused to teach podiatry students and residents for many years because of this snub.
Jeff Carnett, DPM, Phoenix, AZ
07/30/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Discrimination Against DPMs
From: Jonathan Michael, DPM
My daughter is a 1st year student at a college of osteopathic medicine. Next month, I am going to her white coat ceremony. They informed my daughter that they will allow parents who are MDs or DOs to coat their kids, but not a DPM as we are not considered physicians. Also consider, the 3 other schools she was accepted to would have allowed a DPM to coat a student. My daughter is very upset as she told them I am a surgeon and board certified. Their answer was we just call them doctors for respect, but we do not consider them physicians as they have a limited license. Any thoughts?
Jonathan Michael, DPM, Bayonne, NJ
07/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Student Indebtedness
From: Ira Kraus, DPM
I have been watching this item with particular interest. I think that this is an important opportunity for our colleagues not only to donate themselves through the APMA Educational Foundation, but to also impress upon the companies we support that they need to give back, using PICA as an example, to make a meaningful impact on the lives of our students pursuing careers in podiatric medicine and surgery.
When Talar Medical was founded, we made a commitment to address this issue and we to date have donated $50,000 toward student scholarships. We believe that every contribution can make a difference. However, to effectively combat student debt and promote access to education, we need more companies to join us in this cause.
I encourage you to impress upon the companies you utilize to consider how they can contribute to the APMA Educational Foundation. By donating to this worthy initiative, we can help alleviate the financial burden on students and encourage the next generation of healthcare professionals. Together, we can work toward reducing student indebtedness and fostering a brighter future for those entering the podiatric field.
Ira Kraus, DPM, Whitefish, MT
07/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Greg Caringi, DPM
I have read this thread with interest. My OCPM classmate and Kern Hospital co-resident, Dr. Eric Lauf, took on this problem and published his research in 1982, "Manual dexterity: its importance in podiatry" (J Am Podiatry Assoc. 1982 Jun;72(6):291-8.). Since Eric passed much too soon (at the age of 47), I will recall this to the best of my ability. Eric had a friend at the Case Western Reserve Dental School. Even then, dental school admissions took spatial relationships and manual dexterity testing seriously. After observing their metrics, Eric tried to apply them to the students at OCPM.
Unlike dentistry, there was a poor correlation in podiatry. His research became of practical use when Eric introduced the use of the Purdue Pegboard Test (a psychomotor test of manual dexterity and bimanual coordination) as part of the screening process in selecting residents at Kern Hospital. I later began using the Purdue Pegboard at Suburban General Hospital when we selected our surgical residents. It became an important part of our selection process. On a personal note, this reminds me how great a loss it was to our profession when we lost Dr. Eric Lauf in 2001.
Greg Caringi, DPM - North Wales, PA
07/22/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: William Long, DPM
APMA has endorsed several student debt relief bills. Your association also has worked with Congressional leaders for years to support legislation that would create new programs to provide graduates with opportunities to work in underserved areas in order to have their student loan debt entirely eliminated. There are currently several proposals before Congress to address this issue, but the costs are high, and with elections this fall, these bills have dim prospects of being passed.
APMA members are invited to review the list of APMA’s endorsed bills, including those regarding student debt, on our website (www.apma.org/FederalAdvocacy). These proposals are just that— proposals, and it will take monumental support from citizens to encourage elected officials to pass such legislation. APMA employs one full-time lobbyist to support the legislative goals of the profession, as identified by a committee of member volunteers. We strongly encourage members to become politically active. Use our eAdvocacy system (www.apma.org/eAdvocacy), get involved with state and federal candidates, and help us at the grassroots level to support the causes that are important to you.
William Long, DPM, Chair, APMA Legislative Committee
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