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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
Other messages in this thread:
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jon Purdy, DPM
Regarding the post from Dr. Tomczak, I did find that very amusing. I don’t intend to do a back and forth on this, but suffice it to say, I never put someone’s name in print without their permission. I’m sure that person would have been fine with it had I asked.
All associations post-covid have struggled, which necessitated change. As treasurer of the American Academy of Podiatric Practice Management, there has been change required of our own organization. We welcome constructive criticism, as it helps us improve and grow. It’s no different for the APMA. Time will tell, but I like the vibe they are currently putting out, and its leaders seem to be in tune with positive change.
Jon Purdy, DPM, New Iberia, LA
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ron Werter, DPM
What I don’t understand (and maybe the lawyers among us could explain) is how does the insurance company have the legal right to charge the doctor for writing a prescription. The doctor has no financial stake in the prescription; the patient and the pharmacy are the ones who have financial benefit. Is there something in an insurance company contract that says they can do that?
Ron Werter, DPM, NY, NY
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
09/03/2024
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
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.
08/01/2024
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
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Hal Ornstein, DPM
I highly recommend Mike Crosby, CPA of Provider Resources as a practice appraisal expert. He has performed this service for hundreds of podiatry practices and been doing this for many years. He is responsive, knowledgeable, and fair to all parties involved.
Hal Ornstein, DPM, Howell, NJ
05/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Greg Amarantos, DPM
I find it interesting how a post can be interpreted from a different lens and diametrically opposing conclusions are reached. In reading Dr. Tomczak's response to Dr. Roth, I read Dr. Roth's post differently.
While we should believe we are providing the best possible care, we have to face the facts; in private practice, our treatment protocols are at least partially driven by the insurance company policies. I do not read any impugning of the profession. Dr. Roth should believe he is providing the best care, as should you and I. Cash frees the practitioner from the shackles of the insurance company policies. Think of the man hours used on "meaningless use/MIPS" and the like. Dr. Roth reminds me that medicine made a deal with the devil years ago and...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jeff Root
You might want to consider using Quicken Classic Business and Personal if your accounting needs are fairly basic as you suggest. I believe the annual subscription fee is around $120 and costs about half that for the first year. You can set up custom income and expense categories and run income and expense reports that should satisfy your basic accounting needs. You might even be able to import some of your historical data from Quickbooks but you should check with Quicken or Quickbooks support about that first. I have been using Quicken for my personal accounting needs since the 1980s and used Quickbooks for business purposes for many years. I have been very satisfied with Quicken and they have excellent customer support.
Jeff Root, President, KevinRoot Medical
03/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Connie Lee Bills, DPM
We started this about a month ago. Patients are more likely to pay cash or check when faced with a 3.5% fee. My optometrist started it about two months ago and spurred me to follow suit.
I checked with the local credit union and they said HSA cards can be used for the fees as long as they are from a healthcare registered facility. Everyone should be doing this.
Connie Lee Bills, DPM, Mount Pleasant, MI
03/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Robert Scott Steinberg, DPM
"A significant portion of the older podiatric profession are the notional progeny of chiropodists. For many of us, the first exposure to our future profession was afforded by individuals with the letters DSC behind their names." - Tomczak
I highly doubt your statement to be true. Where did you get your statistics? I do not believe there are many 80+ year-old practicing DPMs in any leadership roles in their state or the APMA. If there were, things would not be so messed up!
Robert Scott Steinberg, DPM, Schaumburg, IL
11/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Alan Bass, DPM
I recommend Mike Crosby with Provider Resources. Mike is a CPA and has been in and around podiatry for as long as I can remember. I know that he has helped dozens of our colleagues value their practices in preparation for sale. He also works with DPMs to decide when it’s time to bring on an associate, or value the practice if moving an associate to partnership.
Alan Bass, DPM, Manalapan, NJ
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
09/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell, DPM
Dr. Bardfeld and I go back to the good old days when doctors were independent and we were paid well for our services. We charged patients and no one had druthers about writing us a check for our services. Today all doctors are at the mercy of insurance companies and hospital or corporate owned practices. Two GI doctors I know as well as a prominent cardiologist opted for early retirement after their practices were taken over by a hospital. The hospital had no difficulty however in filling those spots with young guys finishing their fellowships.
What needs to be done is to assess whether young doctors working in and out of hospitals or for corporate entities are happy with their lives as it stands in 2023. If they are happy, then unionization is a pipe dream. On the other hand, if most doctors, especially young ones, are not happy with the way things are going, then there may be room for organized protest in some form or actual unionization.
Elliot Udell, DPM, Hicksville, NY
09/14/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Kathleen Neuhoff, DPM
When I chose to go to podiatry school in 1990, it was partly because the diversity of care that we offered was very appealing. I knew that, thanks to the efforts of previous podiatric pioneers, I would be able to obtain surgical privileges at a hospital to perform procedures such as tarsal tunnel releases and Haglund’s ostectomies which required general anesthesia. I also would be able to perform surgeries such as MIS exostectomies, bunionectomies, and nail procedures in my office. I knew I would also be able to do sports medicine and orthotics, pediatric care such as casting for metatarsus adductus, wound care, diabetic foot care, and “routine nail care”.
I continue to do all of these things. I still make orthotics in our office, have a surgery room with fluoroscopy, power equipment, and cryosurgery. Also, I have added laser therapy and shock wave therapy. I LOVE my podiatric practice and have certainly been rewarded very well financially and with...
Editor's note: Dr. Neuhoff's extended-length letter can be read here.
08/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jeff Kittay, DPM
I am a 1979 NYCPM alumnus, eight years out from practice, and remain a regular reader of PM News. How disappointing it remains to read the same complaints about unfair/limited/denial of payments to duly licensed well-trained professionals, that existed during my 40 years as a student and in practice. The insurers use the same language and excuses they have for decades in denying legitimate claims and/or reducing procedure payments when E/M codes are billed simultaneously, though for an unrelated diagnosis. I see that essentially nothing has changed since I left practice in 2015, which reinforces my decision to leave as the best one for me. The insurers have won the game, set, and match, and there’s nothing any of us can do about it. When the powers that be decided NOT to change the degree from DPM to MD, with all the attendant rigamarole that that would have entailed, podiatry’s fate was sealed.
For those who remain in practice, I can only wish you well, but the cards are stacked against you. I paraphrase Dr. Kass when I state the obvious, there are only so many hours in your day, so many patients you can see and safely treat, and still retain your health, sanity, and family life.
Jeff Kittay, DPM (retired), Pacuarito, Costa Rica
08/09/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Martin M Pressman, DPM
My friend and classmate Allen Jacobs, DPM is rarely wrong and has contributed positively to my 47 year career in numerous ways. His pleas to the profession to be more comprehensive with our evaluation and management of our diabetic patients are a series of benign micro aggressions that I believe moved the bar higher and will prove to be clinically important modalities to reduce amputation rates in diabetic patients.
I would add to his neurological recommendations that every podiatrist learn to utilize an 8 megahertz Doppler to LISTEN to the 3 runoff vessels to the foot plus the popliteal artery. This screening exam will find evidence of PAD with the finding of monophasic sounds in these arteries. We should use the Doppler like a cardiologist uses the stethoscope. Sending these patients for LE arterial ultrasounds will give the referring podiatrist pertinent information with respect to stenosis and oftentimes belies the notion that pulse palpability equals adequate blood flow.
If you document a “plus 1” palpable pulse, you are documenting an abnormality that requires further work-up, you are not documenting adequate flow. Thank you, Dr. Jacobs for your 5 decade efforts to educate our beloved profession.
Martin M Pressman, DPM, Summerville, SC
07/26/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Robert Scott Steinberg, DPM
The Midwest Podiatry Conference (MPC) used to have huge attendance, but no more. The conference is held in downtown Chicago, where the cost of everything is sky-high. It's a killer for exhibitors.
The MPC needs to poll past attendees.
• Is downtown Chicago the draw?
• Do attendees make it a family vacation?
• Would the conference be more attractive for attendees and exhibitors if moved to the suburbs where costs would plummet?
Robert Scott Steinberg, DPM, Schaumburg, IL
07/11/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Lawrence Rubin, DPM
Dr. Zicherman has voiced concerns pertaining to the Medicare billing of CPT codes for toenail avulsion. ThIs link contains current national guidelines that explain the current utilization guidelines for the avulsion codes. There may be some variations among the individual MACs.
I was one of several podiatry Medicare HCFA Contract Advisory Committee (CAC) members who received the first publishing of the revised original nail avulsion guidelines. According to what we were told, these guidelines were mandated by the Medicare Office of the Inspector General, not by HCFA. The reason given for the change was to control "aberrant billing."
Lawrence Rubin, DPM, Las Vegas, NV
07/10/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Matthew G Garoufalis, DPM
The American Board of Podiatric Medicine International was established to give those podiatrists who have not been trained in the United States a pathway to recognition in their field. It is difficult for many Americans to understand the different educational processes outside of this country, as they do not equate to the different levels of training in the U.S. Rest assured that this examination is designed to test at a high level of education that podiatry has achieved in other parts of the world. The exam committee consists of international leaders in podiatric education outside the U.S.
This examination is being heralded by many esteemed podiatric universities globally as a step forward for the profession, and in fact, it is endorsed by the oldest medical multidisciplinary college in the world, the Royal College of Physicians and Surgeons of Glasgow. The standards are rigid, and only those with a certain high level of training outside the U.S. are eligible to sit for this examination. It does not equate those who pass this exam with a U.S. standard, nor was it ever meant to. This will elevate those podiatrists outside the U.S. within their own countries and podiatric communities.
Matthew G Garoufalis, DPM, Chicago, IL
07/04/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Philip Radovic, DPM
I completely support Dr. Saxena's suggestion to settle the ABFAS and ABPM conflict in a just, all-encompassing, and reasonable manner that promotes the well-being of all podiatrists and the public. His proposal, which involves ABPM certifying DPMs for podiatric medicine and ABFAS overseeing the CAQ for foot and ankle surgery, appears to be a sensible and impartial solution that can be executed expeditiously. I urge all parties involved to consider its merits. It is imperative to take prompt action in resolving the issues between ABFAS and ABPM.
Philip Radovic, DPM, San Clemente, CA
06/30/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ivar E. Roth, DPM, MPH
Like Dr. Kornfeld has said, it is up to you to determine your future. You can become a tool of the insurance industry or decide to do something about it. The easiest route is to take the insurance but as you have seen, it probably is not the best route. It takes guts and fortitude to fight forward and take chances. With the insurance, patients will come to you as it is the easiest route. In direct or concierge care, you will have to seek out the patients. It is the exact opposite situation.
While I entered practice in an affluent area, the medical community was very anti-podiatry, so it was not easy but with persistence over time, I developed a great following of cash patients. I have many working people who really should be going to insurance doctors but they want the services that I offer that others do not offer. We do take payments to make it easier and almost all patients are happy to honor their commitment and pay off the services they received from me on time, as I delivered the care they sought.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
06/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Steve Berlin, DPM, Bob Hatcher, DPM
I suggest that you keep your license active in so-called retirement. At age 60+, as long as you are in good health, there are opportunities that pop up. It’s also fun to go to podiatry meetings to meet and greet old friends. It keeps you from going stale and keeps you mentally active. It’s amazing as to what can be in front of you. Why waste that possible opportunity?
Steve Berlin, DPM, St. Thomas, VI
I gave up my NC license 4 years after retiring in 2018, reluctantly I might add, but I think it was the right decision. There are some good reasons to keep your license including:
- opportunities to help colleagues who need short-term assistance with their practices because of illness, or injury.
- boredom, especially for those who don't have other compelling interests to keep them busy. You might want to do a little work on the side after a brief period of retirement.
- possible community medical service in local free clinics or foreign mission work. Lots of possibilities here and most countries do require an active license.
- continued connection with your colleagues and friends while attending CME meetings.
There are also a few reasons to consider giving up your license:
- it ain't cheap to...
Editor's note: Dr. Hatcher's extended-length letter can be read here.
05/31/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Robert Creighton, DPM
Regarding Dr. Rosenblatt's post, "Pot May be a Boon to Podiatry," he states some reasons for a low recommendation rate for podiatry as a career choice based on "decreased reimbursements and competition from other specialties, especially nursing." He then cites a study recently presented at the Society for Cardiovascular Angiography & Interventions concluding that "Marijuana users are at a markedly increased risk of being diagnosed with PAD." He then appears to claim that the increasing trend in marijuana use and its presumed associated increase in the incidence of PAD will counter the ostensible low recommendation rate for a podiatry career.
How does more PAD equate to increased reimbursements and less competition from other specialties, especially nursing? This appears to be a non sequitur. It then seems that Dr. Rosenblatt goes on to reduce the strength of his own argument, stating the increased incidence of diabetes, obesity, and the increased size of the aging population as other trends favorable to podiatry as a career choice, however these trends have largely occurred over the past two decades while the ostensible negative podiatry recommendation trend has occurred. Am I missing something? Please note, my questions are not meant to be interpreted against podiatry as a career choice.
Robert Creighton, DPM, Tampa, FL
04/11/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Andrew C. Schink, DPM, Darryl Burns, DPM
According to my father, a PhD chemist, your jar of phenol is 89%. If it were 100%, it would be a solid. Keep it in a dark place in a brown bottle and it will be fine. If it crystallizes, put it in warm water until it liquefies.
Andrew C. Schink, DPM, Eugene, OR
1- Have a pharmacist make up a 2-4oz bottle every 2 months, depending on your practice use.
2- Give the old phenol back to the pharmacy to dispose of.
3- Keep at room temp, keep it capped as much as possible. This will ensure no crystallization.
This procedure will almost guarantee your results will be consistent. Bottom line: Nails and no phenol burns pay the rent.
Darryl Burns, DPM, Salinas, CA
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