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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
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.
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.
08/01/2024
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
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Edward S. Orman, DPM
I have also used Quick Books for about 30 years. Initially, it was 3-5 years before I had to get a new version. Over the years, the price more than doubled. In 2023, I looked into QB online and ended up purchasing that. I thought I was saving money but was lied to multiple times about the cost. It ended up being more expensive. It's a completely different program, which I didn’t like, with a steep learning curve. I eventually went back to QB desktop. These companies are pigs and don’t care about their clients.
Edward S. Orman, DPM, Perry Hall, MD
04/24/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: W. David Herbert DPM, JD
When I graduated from OCPM in 1976 approximately 500 podiatrists graduated from all 5 schools that year. In 1974, there were 2,500 applicants to our 5 schools of podiatry. I understand less than 600 new podiatrists are licensed every year. I believe as a profession we are barely replacing ourselves. I believe we don't need three years of residency to provide the care that the average podiatrist provides even today. I know that some podiatrists perform total ankle procedures, and obviously a number of years of post-graduate training are necessary for that.
In Wyoming, there are about 15 podiatrists practicing and about 30 are licensed in the state. There are 550,000 people in Wyoming and most podiatrists there are quite busy. We need more emphasis on primary podiatric care and only a couple of years of post-graduate training. A young person entering MD or DO school who wants to perform sophisticated foot surgery would probably not be able to do this unless they were able to get into an orthopedic residency. We could not graduate from OCPM unless we assisted at delivering a baby. That part of my education and training I have really never used. Let's focus on podiatric medicine.
W. David Herbert DPM, JD, Billings, MT
03/30/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: David Secord, DPM
Once upon a time, there was a podiatrist of some note who originally hailed from Michigan. After being mentioned in one of Lee Iacocca’s books (when he was at Ford Motors), this podiatrist (unfortunately) moved to the Corpus Christi area. Mr. Iacocca overheard this podiatrist sitting behind him, talking to his partner about capitalizing upon the UAW provision in their contract which allowed for 6 weeks of paid convalescent care after foot surgery and how they would use this to do a digital procedure on a UAW member. When they were about to go back to work, another digit would be done, and then another, and so on.
With the extended time off, a number of these UAW members would actually have other jobs during the convalescent period and collect two pay checks. Mr. Iacocca got off the plane, met with...
Editor's note: Dr. Secord's extended-length letter can be read here.
08/17/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Ivar E Roth DPM, MPH
Concerning Allen Jacobs’ comments, I could not agree more with Dr. Jacobs. At my local hospital, you must be board certified to apply for surgical privileges. Most of the younger doctors here are using the ABPM as their board to qualify. The hospital thinks a board is a board and has been accepting ABPM as an equal board to ABFAS certification. This is because the doctors applying are saying it is an equal. In my opinion, these doctors are disingenuous. I know for a fact that one of them could not pass or qualify for the ABFAS, but yet thinks he can pull the wool over the eyes of the hospital administration and so far this has worked. Until it is firmly determined that ABPM is not officially recognized as a surgical equivalent, this charade will continue. It is my opinion that ABFAS needs to go on the record and send out letters to all the hospitals in the U.S. and clear up this matter.
Ivar E Roth DPM, MPH, Newport Beach, CA
07/22/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: James J DiResta, DPM, MPH
I read today comments by two of our most esteemed podiatrists Drs. Allen Jacobs and Bryan Markinson on podiatry's scope of practice. I'm certain they are very honest in their comments but their remarks are discouraging. These are two very bright and wonderful people. When you leave their lectures you always come away proud that you share the same cherished profession as them. They are smart. Allen can impress the best of us with his medical and surgical knowledge and insight. As a student at PCPM (TUSPM) in the '70s, I listened intently one day to a lecture he prepared on metal materials for surgical fixation procedures. When I returned home that evening, I didn't feel as smart as I did that morning and frankly if I needed a little more humility that day, he provided it. In my podiatry class at that time was another bright podiatrist to be, Charlie Arena.
Later, Charlie and I would be residents at Northlake Hospital, but before that time while we were doing externships, our paths crossed at a hospital in New Jersey. Charlie was on medicine that month and I was on the orthopedic service. By chance, I was walking in a hall outside a room where the externs on the medical service were meeting and the attending was belittling some of the medical students as he would ask them questions and when they couldn't answer correctly, he would then call on Charlie to answer. Charlie...
Editor's note: Dr. DiResta's extended-length letter can be read here.
05/24/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Allen Jacobs, DPM
People seek care for, and in most circumstances may be treated for, onychomycosis. In some populations, such as patients with diabetes, PAD, chronic edema, immunosuppression, onychomycosis is associated with increased incidence of repeated cellulitis, ulceration, and other significant poor outcomes. We have known this ever since the classic study by Jeffrey Robbins, DPM.
The use of ineffective therapies denies patients who should be treated, or who desire treatment, of effective treatment.
Here is my approach to onychomycosis;
1. Read and consider following the guidelines of...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/16/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Keith L. Gurnick, DPM
Here are some of my ideas. I believe this is a great subject, so others should feel welcome to respond.
1) Do not order one set of "compromised" custom orthotics that will work in all varieties of shoe styles for your patients. You will end up with an orthotic that still doesn't fit in some shoes and also doesn't function well enough in the shoes they do fit into. On those patients who will require different types of orthotics because they wear different shoe styles, make one set for the most important shoes and wait a bit and then make other sets at a different date when you see how your patient responds to the first ones.
2) Never, never, never make multiple sets of orthotics at the...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
02/09/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Cosimo Ricciardi, DPM
When I read the parity discussion, I consider the multiple ways this term parity is understood. From a collegial equality perspective, I look back on the considerable effort it took to bring podiatry out of the antiquity of needing ortho approval to repair a hammertoe, and into a full scope and unrestricted surgical privilege within our specialty as it is today. My practice treats local doctors, their families, and their children. We receive hospital consults as a part of a limb salvage team. In short, I have never felt "less than" because I have never allowed it to be so. I feel, in this regard, parity with our colleagues is what the individual allows it to be.
Parity in pay, however, is a different story. We currently have no control over this. How, with significant focus on equality being present, are we still paid "less than"? How, technically, could a general surgeon perform and get paid more to repair a bunion than the best of us? This is completely irrational. This, I offer, is the true argument to be made about equality. The equality of the individual practitioner can be shaped by the individual. Pay inequality cannot.
Cosimo Ricciardi, DPM, Fort Walton Beach, FL
08/12/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Lawrence Oloff, DPM
This subject seems to have a cycle and I guess it's that time again. I think it is interesting that we want to be treated with respect and parity by the allopathic medical community, yet we don’t want to be held to those same standards. I am not sure what it is like in your communities, but in mine, orthopedic surgeons are required to be board certified to have surgical privileges. Hospitals realize that surgeons (podiatric and otherwise) are not going to be board certified when they complete their residencies. They grant a reasonable time period for recent graduates to obtain board certification status. Not that long ago, one of the orthopedists, at one of the hospitals I work at, was unable to pass the exam after several years. His surgical privileges were then revoked. Too strict? Maybe, but their rules.
The specifics of what privileges are granted is up to the hospital and is vetted by applicant surgeons submitting supporting documentation of their surgical experiences. I imagine we have all gone through much the same process, the same process as our allopathic colleagues. Surgical privileges in the allopathic world means...
Editor's note: Dr. Oloff's extended-length letter can be read here.
08/11/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Vadim Goshko, DPM
I would be interested in hearing opinions on a view from different angle. Maybe the DDS model is more fitting for the world of private practice podiatry? What if those who claim “hospital surgical privileges” (as oral surgeons do), would legally drop their general practice and build practices fully dependent on referral from “non-hospital privileged” podiatrists and any other strictly surgical referrals.
“General practicing” podiatrists, by the way, still could perform surgical procedures (obviously, based on their training) in the quiet of their offices’ surgical suites (if they chose to have one). I’d like to see how those surgical podiatrists would like to compete for those cases (with MDs as well) and depend on referrals from their colleagues? The fact that there are few residencies that actually provide excellent training non-withstanding, let those graduates forgo their general podiatry practices.
Vadim Goshko, DPM, Chicago, IL
08/10/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Neil H Hecht, DPM
Just a quick comment about a recent post that quoted “allopaths protect their own” when there is discrimination from MD vs. DPM in granting hospital surgical privileges. Podiatrists ARE allopathic doctors. We do practice allopathic medicine, not homeopathy. We are trained exactly like traditional physicians albeit focused as a regional specialty.
We may have a full-scope license in a limited portion of the body, but we all practice allopathy. If you don’t believe it, look up the definition of allopathy vs. homeopathy. Just my two cents after practicing allopathic podiatry for 42 years!
Neil H Hecht, DPM, Tarzana, CA
08/07/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Bryce Karulak, DPM
While I absolutely agree with Dr. Rogers’ point of view, this is simply not the case in Texas and I imagine in most states. I am dual board certified by both ABPM and ABFAS with both foot and RRA. Yet, I have been denied privileges even though I demonstrated training in residency and competence at other hospitals in the region that I DO have those privileges at. I have never had a malpractice suit to date. Yet my request was still denied. We (podiatry) are not considered the same and are held to a different standard than any other physician/specialty. Allopaths protect their own; we don’t protect our profession.
Bryce Karulak, DPM, Fredericksburg, TX
07/16/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Alan Sherman, DPM
As co-founder of PRESENT e-Learning Systems, podiatry’s largest online education provider and among its largest live CME conference providers, Dr. Sasiene rightfully questions why his state of Texas limits online education to only 40% of what is required. We have been running an extensive information campaign to raise the awareness of our colleagues as to this issue. And yes, I have skin in both games here, but it continues to seem wrong to me that any state limits online CME, as 22 states currently do, especially this year.
Dr. Ribotsky finds a lack of passion in online education compared with live CME events. We’ve been thinking about that a lot as we plan to run our first live meeting in the COVID era, Superbones Superwounds East 2020 in Teaneck, NJ, August 14-16, because besides live conferences offering us lectures by passionate speakers, they also are satisfying professional networking experiences. I find them to be a lot of fun. We are confident we can keep our attendees, who are all foot surgeons and as well trained in safe and effective infection control procedures and practices as anyone, safe. The challenge is making it fun. We will do our best. Our model for running a safe meeting will likely be studied carefully by so many entities that hope to run meetings in this period before we have an effective vaccine.
Alan Sherman, DPM, CEO, PRESENT e-Learning Systems
06/10/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Jack Ressler, DPM
I cannot give an answer as to the effects concerning catching COVID-19 by inhaling nail dust during debridement. I have included a short video we made a few years ago which shows the difference between using and not using a nail dust extraction system. This video shows the amount of nail dust that becomes airborne during debridement. As you can see, the amount of particles/dust that is produced is very concerning. The video shows the difference in the amount of nail dust produced with and without using our nail dust extraction system. I am sure eventually there will be studies showing the possibilities of contracting COVID-19 from inhaling nail dust particles during debridement. Even without that threat, we all know the significant health hazards to ourselves, staff, and patients breathing in nail dust during patient care.
Jack Ressler, DPM, Delray Beach, FL
03/24/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Joseph Borreggine, DPM
Since every podiatrist in the country will be affected by the COVID-19 pandemic financially in an unprecedented way, then federal assistance may have to considered. This can be obtained through an SBA loan program which will cover necessary business expenses, needed inventory, payroll, and outstanding liabilities.
This may be your best option to keep your practice afloat until things return to “normal”. Here is the SBA site online. What is interesting is that the ADA is lobbying Congress to help protect dental practices from undue financial stress at this time. They recently stated, “The ADA will be working to ensure that those provisions will benefit our dentist owners.”
I wonder what the APMA and the ACFAS are doing to fight for the same thing for podiatry?
Joseph Borreggine, DPM, Port Charlotte, FL
04/12/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
RE: Using DPM Degree Outside of Podiatry
From: Joe Agostinelli, DPM
I have been following this discussion closely and would like to present comments from experiences in my 23 year USAF active duty military career and then 14 years in private practice as a DPM in a large orthopedic surgery/sports medicine group. Ultimately, it is not the "degree" that allows other than podiatry utilization, but the "person."
While in the military, I found that when it came to additional duties such as - ACLS instructor and affiliate faculty, trauma management lectures, executive committees of medical staff, chief of surgical services (including orthopedics), etc., my actual degree did NOT matter! It was the...
Editor's note: Dr. Agostinelli's extended-length letter can be read here.
04/10/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Simon Young, DPM
Bottom line... we have a limited license. MD/DO/NP/PA all seem to be able to treat the whole body (give or take). We can't even give a flu vaccine in NYS. My local pharmacist can. Others can be hired in hospitals and by insurance companies. Unless there is a special niche, or someone wants specialized opinions, we don't fit the majority of needs. Unless we are able to increase our scope of medical (not surgical) practice, we are stuck.
Simon Young, DPM, NY, NY
04/09/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Allen Jacobs, DPM
Several years ago, podiatric students from California took the USMLE examination. In point of fact, the podiatry students performed horribly in the examination. The results of this testing was to test the current status of general medical education in the podiatry schools. I suspect that medical students would fail the podiatry national boards.
If the objective of podiatry school is to prepare students to pass the USMLE examination, a restructuring of the current state of education within the podiatric colleges would be required. This would involve more than simply adding coursework in three areas. Clerkships and rotations would also have to change. Students and residents would have to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
01/03/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Robert Scott Steinberg, DPM
At the CME meetings I attend, there are multiple tracks going on at the same time. I do not see how Dr. Silhanek knows who does or does not attend lectures! Getting together with colleagues should not be dismissed. I am not a fan of online CME. Oh sure, it's easy, maybe far too easy. Yes, it is cheaper. What I think is more problematic is the money being taken away from state associations when someone pays to attend non-member organizations' CME - part of what helps to keep our dues down is the money that comes from state association-sponsored conferences.
Robert Scott Steinberg, DPM, Schaumburg, IL
11/28/2018
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Spencer F. Dubov, DPM
In response to Dr. Smith’s article concerning proper attire in the office, it has always been my view and experience of 55 years in practice, especially running courses in “Practice Administration”, that proper business attire sends a positive message to your patients of respect for them, yourself, and your profession. Wearing a white lab coat requires a business shirt and tie, or surgical scrubs. Nothing short of that is acceptable. When you visit a lawyer, his dress code is a suit and tie. Why would anyone want to present with a lesser appearance as a podiatric physician? The key is to “Dress for Success!”
Spencer F. Dubov, DPM (Retired), Naples, FL
04/06/2018
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1c
From: Harry A. Harbison, DPM, Elliot Udell, DPM
I always find it interesting that podiatrists seem to think "custom orthotics" are a prescription-requiring item. Please be aware that in-shoe orthotics (i.e.- ala Root style) do not require a prescription in any state or province in the USA. There are no requirements that a "medical professional" be involved in the fabrication of these items. To have these items paid for under a third-party payor may require some sort of "prescription" for medical necessity documentation.
Harry A. Harbison, DPM, Long Beach, CA
We use a scanner in our office to send images to a lab. It's not rocket science and I had no delusions that non-podiatrists would use the same technology. Chiropractors, orthotists, and PTs are making custom orthotics and some use the same labs that we use. Now it's Costco.
The question we should be asking is how to manage the patient who gets a custom set of orthotics from Costco and then asks us to make adjustments to help manage his or her foot problems. I already encountered this problem in my office and wonder how others will approach this problem.
Elliot Udell, DPM, Hicksville, NY
03/01/2018
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Brian Carpenter, DPM
I think this is a very important question/observation by Dr. Borreggine. Dr. Saxena mentions George Liu, DPM recently ran for the ACFAS board (and won) on the platform that DPMs need to do more research and start maintaining registries which I 100% agree with.
One thing that Dr. Saxena did not mention is that we have a very large and powerful society, The American College of Foot and Ankle Surgeons, which states that part of its mission/vision “is to advance and improve standards of education.” The college has over 300 volunteer leaders serving on committees and serving on educational faculties. One of their strategic initiatives is to “advance scientific and clinical research to maintain leading edge competency among our members“ and “deliver superior continuing medical education to enhance competency at every level of professional training.”
Just as with the residency programs, the College is rewarding those with little to no academic experience or background and placing them into leadership and educational roles. Good examples of this are at the Annual Scientific Meeting in Memphis next month. They have 12 speakers who have never published in the Journal of Foot and Ankle Surgery (JFAS), the College's own journal. There are currently 4 members on the Board of Directors and 52 committee members who also have not published in the JFAS. For us to truly gain parity in medicine, we have to be doing the work of the other medical professions, and research and publishing are at the top of the list that we are lacking in.
Brian Carpenter, DPM, Fort Worth, TX
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