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09/25/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Jon Purdy, DPM
I would like to submit an update to my previous post. After speaking to one of APMA's leaders, I am happy to learn of recent developments. They have been making some significant cuts in expenditures and have plans to do more. The new leadership has voiced an understanding of where things are and where they need to go, which is exciting.
I think we would all love to see a national campaign in the future if that’s possible.
Jon Purdy, DPM, New Iberia, LA
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
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Kornfeld, DPM
I thoroughly enjoyed reading Dr. Tomczak's post about how exciting it is to have a new APMA administration that finally understands what is happening and is going to do something about it. Well, I am a 1980 graduate of NYCPM. If you do the math, I graduated 44 years ago. And during all 4 1/2 decades that I have been a podiatrist, APMA has been "working" on making things better for us. Sometimes, they work "hard" at making things better. Yet, in all these years, not only has it not gotten better, it has gotten so much worse.
I won't go into details about my personal issue with my own NYSPMA which I quit many years ago, but what I will say is if anyone out there wants to make things better, you need to stop counting on APMA and do it yourself. When I realized that nothing was changing for the better, I decided to do it myself. And to be honest, my efforts to improve my professional experience all paid off without dues to an organization that is always working hard for us but never seems to accomplish what they promise.
I'm sure I'll catch some backlash for this, but my career is nearly over and I don't care what they have to say about me and my opinions. Of course, what I have already heard is if I'm not a dues-paying member, then I'm part of the problem. Nah. My career was amazing in spite of, not thanks to, APMA.
Robert Kornfeld, DPM, NY, NY
09/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1A
From: Lawrence Rubin, DPM
Dr. Purdy has posted that he would love to see a national APMA public relations campaign in the future if it is possible. So would I and many others. And it is possible. One means is teaming up with collaborating partners to develop robust campaigns that present podiatrists as the nation's preferred foot and ankle specialists. For example, I am happy to report the potential for a collaborative national public health improvement campaign of APMA members teamed up with Lions Clubs International (LCI) members.
The Lower Extremity Amputation Prevention (LEAP) Alliance, a 501(c)3 non-profit charity, has informed APMA that it has developed a collaborative diabetes limb saving program with LCI administrators and local Lions Clubs members. There are about 1.4 million members worldwide, and Lions members support community- based programs that enhance prevention, control, and management of diabetes and its complications - two of which complications are diabetic peripheral neuropathy (DPN) and peripheral artery disease (PAD).
There are potential donor funds and LCI granting programs that potentially can help defray costs. (See grant information: LCIF Empowering Service: Diabetes) What's more, LCI leader members have expressed interest in advancing collaborative efforts with APMA to provide the Lions Hunt for Diabetic Peripheral Neuropathy (DPN) and Peripheral Artery Disease (PAD) Free Foot Screening Program. APMA is successfully putting podiatry in the limelight through collaborative efforts with the American Diabetes Association (ADA). We shall see if an APMA-LCI team up can also be worked out.
Lawrence Rubin, DPM, Las Vegas, NV
09/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Rod Tomczak, DPM, MD, EdD
I wonder if Jon’s letter was written tongue in cheek. If accurate, Jon’s report about a recent encounter with a secret agent from APMA who assured Jon there are changes a comin’ at APMA headquarters gives cause for celebration. That’s tongue in cheek. If what Jon was told is indeed true, and why should we doubt anything out of the mouth of an unnamed secret APMA leader, then I am grateful that the spirit of Deep Throat is alive and well in Washington, DC. One difference between the original Deep Throat and the APMA Deep Throat is that the current mole is wearing old Rohadur orthotics posted to the casts to throw off younger potential trackers.
But there is a disparity between these new APMA promises and those made in the waning moments of the Nixon administration. Deep Throat’s assertions proved to be true. Both the current APMA Deep Throat and the Watergate Deep Throat were accurate when they presently advised Purdy and in...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: “Why I Chose an NP for My Care” National Commercial
From: Jon Purdy, DPM
If there’s a will there’s a way. The end result is more applications to podiatry school and increased income for practicing podiatrists, both of which result in increased income for the APMA. The APMA, like most large regulatory associations, has expenses that can be reined in. Large expenses for committee meetings can be reduced as well as many of the bloated salaries and lavish meeting expenses for the anointed. Even so, it would be a struggle to fund a national TV campaign. That is why many partner with other symbiotic associations and companies.
Jon Purdy, DPM, New Iberia, LA
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Kathleen Neuhoff, DPM
I have always found it interesting that when gabapentin was only available as Neurontin, insurance companies would not pay for it because it was off-label use. Then Lyrica came on with it on-label used for diabetic neuropathy, but at a high cost. So, the insurance companies would decline Lyrica until the patient had tried and failed gabapentin, which was still off-label.
We all know that cost is never considered an adequate reason for choosing a drug, so when my patients would decline Lyrica, I had them sign a consent form advising them that we were using gabapentin in an off-label manner, and that they had declined my recommendation for Lyrica.
I do the same thing when I am using something off-label for surgeries. For example, I use cryoablation for most of my neuromas with very good success, but I have the patient sign a form telling them that the instrument I’m using was not designed for neuromas. Many of my colleagues thought I was a bit paranoid, but maybe I was not!
Kathleen Neuhoff, DPM, South Bend, IN
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Justin Sussner, DPM
But how often do all of us get a fax or email or phone call that "ABCD" antifungal cream needs pre-approval, all for what may be a $20 generic. Isn't it the insurance companies' fault for not requiring the big ticket items to be pre-authorized first? This doesn't make sense to me. Maybe they just don't trust DPMs, and let the MDs do whatever they want.
Justin Sussner, DPM, Suffern, NY
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
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From Elliot Udell, DPM
Thank you, Dr. Kesselman for making us aware of this new way in which insurance companies may finally put an end to the practice of medicine.
On one hand, I understand where they are coming from. Drugs like Ozembic are high ticket items and if insurance companies were forced to pay out thousands of dollars for every patient who refuses to try diet and exercise and would rather take injections, they would either go belly up or would have to raise everyone's premiums through the roof.
On the other hand, if I had to pay back for every script I have written for gabapentin or cortisporin otic solution, bankruptcy would definitely be in my future.
Elliot Udell, DPM, Hicksville, NY
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Back to the Future
From: Steven Finer, DPM
Upon reading the new issue of Podiatry Management, I counted ten ads for various creams and lotions pertaining to skin, nails, and pain relief. There were other ads for orthotics and podiatry-related machines. I have a 1962 Journal of the American Podiatry Association. It contains three ads for prescription internal medications. Also there were various ads for skin, nails, and orthotics. I know the various surgical magazines feature countless ads for surgical instruments and devices.
Must we now read internal medicine journals and use the Internet to review the latest medical news. I know everything is segregated in medicine, but this 62 year old journal was ahead of its time.
Steven Finer, DPM, Philadelphia, PA
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Robert Scott Steinberg, DPM)
Dr. Udell's comment underscores our problem—old thinking. Who said anything about a million-dollar ad campaign? I suggested using much of the costs put aside for the HOD on an advertising campaign. And if states only sent the president and president-elect to the much smaller HOD, states would have money to advertise, as well.
Robert Scott Steinberg, DPM, Schaumburg, IL
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3B
From: Lawrence Rubin, DPM
Dr. Udell has posted that expecting the APMA to invest millions of dollars into national advertisements is a great idea but in reality it boils down to a pipe dream. I agree with Dr. Udell. We cannot expect APMA to invest millions of dollars into national advertisements. But, although it may require a modest increase in the costs of special human and outsourced resources, it would not cost APMA anything even close to millions of dollars to expand its efforts to put podiatry in the public limelight by employing "guerilla marketing" tactics (Getting great marketing results with minimal expense through advertising creativity).
This creative guerilla marketing could include launching an easily promoted Internet newsroom especially for news and feature reporters and healthcare media copywriters. It can have interesting news releases and feature stories that highlight why podiatrists are best educated and equipped to improve the lives of our footsore public. There could also be collaborations with nonprofit health groups in order to to create and distribute social media PSA print and videos (Public Service Announcements at no charge by the publisher) that present podiatrists as the nation's preferred foot care physicians. These PSAs are not prohibitively expensive to generate and can be easily emailed to literally thousands of national media. And, we could also include these PSAs on our individual websites.
In addition to this, there could be an inexpensive complex hub website that could provide information for the public and even lead potential patients directly to podiatry practices. APMA is without doubt doing a good job with its allocated marketing financial resources. We just have to find ways to modestly but significantly increase those financial resources in order to better reach our goals.
Lawrence Rubin, DPM, Las Vegas, NV
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Recoupment Responsibility for Prescribing Ozempic
From: Paul Kesselman, DPM
While podiatrists rarely if ever prescribe Ozempic, a recent story in my local newspaper (Newsday) yesterday caught my attention sending shivers down my spine. Apparently, some insurers (UHC was named as one) are targeting physicians who prescribe medications off-label. They are now asking the physician for recoupment for the money they had reimbursed for Ozempic when the physician prescribed this off-label. One physician is facing a $125K recoupment merely for writing prescriptions. Interestingly, he is not being accused of falsifying medical records to get patients covered for Ozempic because he never did. He essentially prescribed Ozempic for weight loss and nothing else.
How many physicians (including DPMs) have written off-label prescriptions? I dare say most, if not all. In the podiatry world, prescribing Neurontin for neuropathy or chronic pain and cortisporin otic solution (neomycin and polymyxin B sulfates and hydrocortisone otic solution) post-matrixectomy easily come to mind. There are certainly many examples, all of which set a dangerous precedent if insurers are allowed to recoup money from providers who simply write a prescription for a medication which works, but for a non-FDA-approved purpose.
Medicine must fight this latest incursion to muzzle our independence and thus prevent our ability to provide our patients with the care they deserve. Unfortunately, the insurance companies are often shielded from legal action brought by patients who are denied coverage by their insurance carriers. Now the insurance companies want to sue us for the mere act of prescribing medications for purposes they don't agree with. The playing field is continuing to be unfavorable for physicians and it's high time we put a stop to this.
Paul Kesselman, DPM, Oceanside, NY
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: David Secord, DPM
My experience was somewhat the opposite, in that an anchor for one of the local television stations happened into my office for a nail procedure, worried that it would keep her from wearing stylish (I would go with inappropriate, but there you go) dress shoes as part of her work and that everyone she knew assured her that the experience would be akin to a slow trip through hell. She was amazed that she didn’t feel the injection stick (ethyl chloride) and didn’t feel the injection (1% lidocaine with epi, 0.5% Marcaine plain, 8.4% sodium bicarbonate to buffer the injectable back to physiologic pH) and didn’t have any pain after the procedure (no tourniquet needed due to the use of epi in the block). She recommended that the anchor at another station in Corpus Christi see me, as she had the same problem and staved off the procedure for the same reasons. She had the same positive experience.
The two of them began a discussion with me about my practice and I mentioned that...
Editor's note: Dr. Secord's extended-length letter can be read here.
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
Along with others in this thread, I am also an APMA Life Member who has no vote and is grateful to Barry Block for giving us an invaluable platform to voice our opinions. Relevant to this thread, back in 2012, I was very active in several APMA activities and worked together with other podiatrists throughout the nation and APMA assigned program personnel in providing the, "Knock Your Socks Off" public information campaign. APMA launched this public service program to educate the public about amputation prevention and other foot healthcare matters, to create awareness of the broad scope of our podiatric practices, and to show the public that we are the preferred providers of footcare.
Although the program was magnificent in structure and content, it depended upon APMA members in all states and communities working closely together in conforming to a program implementation plan. I was assigned the State of Nevada, and was pleased to report that the program did raise community awareness wherever the local volunteer DPMs were willing to participate in the program. Unfortunately, too few podiatrists nationwide were willing to get involved personally or assign their staff members to provide the program elements. For this reason, the program had to be discontinued.
When the Knock Your Socks Off Program was discontinued, I and a small group of Las Vegas APMA members who were providing the APMA Knock Your Socks Off program elements joined together in 2010 in order to help to create the non-profit Lower Extremity Amputation Prevention (LEAP) Alliance. LEAP creates community-based lower extremity amputation prevention programs in collaboration with local healthcare and community services entities.
Lawrence Rubin, DPM, Las Vegas, NV
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - 2C
From: Elliot Udell, DPM
Yogi Berra used to say, "It's deja vu all over again." This discussion brings back memories from the 1980s when I was on the board of my county podiatry association. The topic of having our state society and the APMA do massive television commercials was on every practitioner’s mind. The only problem with it back then and even today is that we are a small profession. The total amount of dues collected by our professional societies is miniscule as compared to NPs, or even MDs. Expecting the American Podiatric Medical Association to invest millions of dollars into national advertisements is a great idea but in reality it boils down to a pipe dream.
Elliot Udell, DPM, Hicksville, NY
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
09/18/2024
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.
09/17/2024
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
09/17/2024
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 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
09/16/2024
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
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
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