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09/16/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: “Why I Chose an NP for My Care“ National Commercial
From: Allen Jacobs, DPM
I just watched an extremely interesting commercial on Fox national television. The commercial was called “Why I chose an NP for my care“. The commercial highlighted the benefits of seeing a nurse practitioner. Obviously, this was in preference to alternative healthcare providers. This is exactly the type of proactive advertising that has been lacking in our profession. The growth of podiatry has been totally dependent on each individual practitioner and their accomplishments and advancements at the local level.
Informing the public of the benefits from evaluation and treatment by a podiatrist in preference to other healthcare providers for evaluation and treatment of foot and ankle pathology is what the APMA should have been doing for years. I for one am tired of seeing restricted announcements by the APMA regarding fungus, toenails, proper shoe selection. and basic first aid Boy Scout merit badge level advice. The advertising campaign of the nurse practitioners seems to me to be very effective and again represents the type of infomercial that our leadership should be engaged in generating. I cannot help but think this would also increase recruitment to our colleges.
Allen Jacobs, DPM, St. Louis, MO
Other messages in this thread:
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Rod Tomczak, DPM, MD, EdD
Allen Jacobs' letter on why one chooses an NP for care piqued my curiosity, but in a tangential direction. I began to wonder about the APMA Seals of Acceptance/Approval. The APMA states it desires to provide information for podiatric physicians, their patients, and the general public to ensure they can make the best possible decisions regarding foot health. On their website the APMA states the Seal is not an endorsement. Shakespeare said it best, “A rose by any other name is still a rose.”
There is a committee that determines which product is fit to use the seal/logo of approval. The members of the committee are confidential according to the APMA website. I understand. God forbid an approved treatment for bromhidrosis does not work for someone. This NSA committee is protected from retribution and the need for Witness Protection, which can get very expensive. The APMA website stresses safety and utility and the need to submit various documents to the APMA proving efficacy. They do not mention if there is a fee for evaluation of a revolutionary flip-flop seeking...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ivar E. Roth, DPM, MPH, Jeffrey Trantalis, DPM
Dr. Jacobs is correct. WE the profession, APMA, need to fund a campaign on TV to get the word out about our services. I had a local Dr.’s wife who was treating with an MD orthopod foot and ankle fellowship trained with the usual hands-off approach. The patient had an ulcer that was infected and very callused. When she saw me, the first thing I did was debride the callus which gave her immediate relief and now the ulcer could also drain properly, etc. Let’s make this happen. Good observation Dr. Jacobs.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
Dr. Jacobs is correct in the ability to promote podiatry as a profession. However, because of my experience working for a back surgeon, we as a profession can take it a step further promoting non-surgical care for the lower extremities and lower back. People are not aware of our training and skills in the biomechanics which provides a non-surgical approach to the complete lower extremities and lower back care.
Jeffrey Trantalis, DPM, Delray Beach, FL
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Kathleen Neuhoff, DPM
Sadly, I must agree with Dr. Doms. I was president of the American Animal Hospital Association years ago and we investigated the cost of such a campaign. It was many millions of dollars. At that time, there were about 50,000 veterinarians. It would have required a donation of more than $500 each if EVERY veterinarian contributed. We polled our members and the average they were willing to contribute was $100. And we knew from PAC contribution records that less than 10 percent would actually contribute, so it was not feasible.
The advertising we have been able to do has been primarily supported by our vendors but I suspect the amount of money spent by clients for products such as pet foods, cat litter, flea products, etc. far exceeds the amounts spent by our patients for podiatric-related products. It is certainly possible that some of the podiatrists reading this would be happy to contribute $1,000 each year for a PR campaign, but I suspect most would not.
Kathleen Neuhoff, DPM, South Bend, IN
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Pete Harvey, DPM, Stephen Doms, DPM
Kudos to Dr. Jacobs for his astute observation of NP advertising! I fervently hope some podiatry entity will pursue this.
Pete Harvey, DPM, Wichita Falls, TX
With all due respect to Dr. Jacobs, the number of nurse practitioners is about 385,000 according the American Association of Nurse Practitioners. They graduate about 39,000 each year (Fact sheet, AANP). With those numbers, they can afford to advertise. We graduate about 500 DPMs each year. They outnumber us by 20 times or more. Our profession is so small we could never compete with their kind of national television advertising.
Stephen Doms, DPM, Hopkins, MN
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Scott Steinberg, DPM
I can tell you why the APMA doesn't do something similar: money and how they spend it. It is costly to put on the HOD. The budget for the 2024 HOD was $234,000. The Illinois Association of Podiatric Physicians and Surgeons has budgeted $20,000 for the 2025 HOD. Each state could use some of what they budgeted for the HOD to promote our profession. The APMA could do the same.
Nothing Earth-shattering happens at the HOD that necessitates hundreds and hundreds of delegates going to DC. The HOD recently ditched Roberts Rules of Order for Sturges for no practical purpose other than acting like they are the House of Lords. If you go to Facebook and search for plantar fasciitis, you will then be inundated with ads from PTs, DCs, and others who claim to be the experts. I rest my case.
Robert Scott Steinberg, DPM, Schaumburg, IL
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Howard Bonenberger, DPM
I cannot agree more with Dr. Jacob's letter. I feel secondary embarrassment when reading a post, presumably from social media or print material, quoting a podiatrist about foot odor, Dante's flip-flop hell, shoe selection, and ingrown nails.
I experienced something that may be partially at fault: years ago a local writer asked for an interview. She came with a list of questions which would have produced the very subject matter we are denigrating. I realized that she knew little about our training and skill level. I walked her through a typical week of sports injuries, fracture care, office and hospital surgeries, diabetic care, and C & C. She was a little embarrassed and very grateful for the eye-opening education. She actually became a patient and referred many others over the years.
I suggest that when asked to be interviewed for an article, podiatrists provide a thoughtful, short summary of a typical week and educate the interviewer. Plan ahead, please use spell check and proper grammar. Send them to various health news outlets. I have never read an interview with an orthopedic foot and ankle doctor who is discussing buying junior's shoes. It is because the interviewer would never deem to insult them with such lowly questions, after all...they are seen as well-trained physicians and surgeons. Until we, as a profession, set the table of expectations, not much will change.
Howard Bonenberger, DPM (Retired), Hollis, NH
09/13/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Alex Dellinger, DPM, Brian Zale, DPM
I, too, used Cantharone and Cantharone Plus for years. After it became impossible to get, I took an empty bottle of the Plus across my parking lot to Cornerstone Pharmacy who compounded a perfect replacement. I have been using this version successfully for about a year and a half.
Alex Dellinger, DPM, Little Rock, AR
There is no need for an alternative. I get my Cantharone and Cantharone Plus from Canada shipped to me. Here is the lab. Dormer Laboratories, Inc., Toronto, ON
Brian Zale, DPM, Rosenberg, TX
09/04/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Dr. Scholl’s Callus Removers
From: David T Weiss, DPM
After 30 years of treating feet, I’m still perplexed about WHY these are still on the market, especially in our litigious society. This morning, I had yet another patient come in with an infection from using these “Corn Removers” - salicylic acid patches.
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Dr. Scholl's Callus Remover - New Look, Same Danger! |
I see in small font there is a “disclaimer," but even so, almost weekly, I have a patient with a chemical burn, sometimes even deep to the subcutaneous tissue. What am I missing here? Why are these things still on the market? I appreciate your honest, factual responses. It can't solely be for the company’s bottom line that makes them.
David T Weiss, DPM, Richmond, VA
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Donald R Blum, DPM, JD
Many years ago, I would have agreed with your hospital. That is the assistant should be as qualified as the primary surgeon. In the past, the assistant surgeon should have been able to give input to the surgeon and opinion during the procedure. However in today’s world a “certified medical assistant” is allowed to assist in surgery and in many cases also bill an assisting fee. Many times, this is out-of-network which greatly benefits the employing surgeon. This is possibly a good argument for allowing the DPM to assist on procedures with the privileged DPM.
Additionally, having a podiatrist assist whether trained in the particular procedure or not should decrease the OR time as the primary surgeon will be more efficient, and one could expect better outcomes as a result. Efficiency would occur as the assistant is more knowledgeable of the instrumentation and order of the procedure. Setting up power equipment, aligning a fixation wire or other hardware will be easier with a podiatrist, even one who does not do the procedure on a regular basis. The language and skill of the DPM assistant beats the knowledge of a “PRN” medical tech or a permanent OR medical assistant employed by the hospital but typically does general surgery or non-orthopedic procedures.
An item which the assisting podiatrist needs to check on is whether one's malpractice will cover them for these more involved procedures. Many times a doctor doing non-boney procedures will have a different medical liability coverage than one doing bone and tendon/ligament work.
Donald R Blum, DPM, JD, Dallas, TX
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jerry Peterson, DPM
No, you are not missing something. He should be able to assist ANY physician on ANY surgery. In Oregon, a podiatric physician can assist in general surgical procedures, Ortho, Neuro procedures, etc. They are not required to have the privileges to be able to assist. Good luck moving forward.
Jerry Peterson, DPM, West Lynn, OR
09/02/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: H. David Gottlieb, DPM
Reviewing this current topic, I have started and deleted several multi-paragraph replies. The topic is addressed by most, if not all self-help and self-improvement lectures, books, and tapes/CDs/podcasts. And the answer is always this: The only person who defines who/what you are is you.
H. David Gottlieb, DPM, Baltimore, MD
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
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