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03/27/2014    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Arnold Ross, DPM, Burton J. Katzen, DPM


 



I enjoyed the three-year program. Unfortunately, the plan to have more grads was questionably calculated. In California, the old CCPM had approximately 100 students per class with a podiatric hospital and fully functioning orthotic lab. Now, we have two schools in California with approximately 100 students or less in total, and no hospital or orthotic lab in either.


 


Arnold Ross, DPM, Los Angeles, CA, asross1@juno.com



 


I cannot believe that anyone in our profession could possibly vote for the 3-year podiatry curriculum. Before I looked at the results, I thought the voting would be less than 1%. First of all, as one of my colleagues stated, there is way too much to learn for even four years. Also, for those of us who have been around for over 40 years, if you think we were looked down upon by our medical colleagues and the general public in the past, this would be a public relations disaster, not to mention a credentialing disaster for hospitals, etc.


 


One viable alternative would be a 6-year college/podiatry degree program like Hopkins and several medical schools have, or at least I know had in the past. This would especially be a viable alternative for schools affiliated with undergraduate schools like Temple. Also, we're the only profession that is trying to force every graduate into becoming a surgeon with a 3-year residency to even get a license in most states. This is extremely detrimental and costly to the students wishing to provide for patients needing other types of care, and for our profession in general.


 


Burton J. Katzen, DPM, Temple Hills, MD. DrburtonK@aol.com

Other messages in this thread:


03/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Robert S Steinberg, DPM, Howard R. Fox, DPM


 


I have given up on carbocaine. No excuse not keeping up with demand, or at least letting physicians know what's going on. I switched to 2% lidocaine and add sodium bicarbonate. I’m happy to report that it works just fine.


 


Robert Scott Steinberg, DPM, Schaumburg, IL 


 


Polocaine (mepivicaine) 1% and 2% is in stock and available from McKesson.  I just bought 4 50-cc vials from their Farmington, CT location. It appears that carbocaine is no longer available. 


 


Howard R. Fox, DPM, Staten Island, NY

03/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: David Secord, DPM, Robert S. Schwartz, CPed


 


I don't really have a suggestion of a shoe for this person and don't know how they would be affordable, as it would likely be a custom-made job and not reimbursed by insurance. I did just read this article and thought it topical.


 


David Secord, DPM, Corpus Christi, TX


 


One of the great pedorthic custom shoemakers, Arnie Davis, practices in San Francisco. Hopefully, your patient can get there. Eneslow celebrates 110 years in New York City helping patients like the one described with custom shoes for Charcot and any other deformities requiring custom made footwear. Often the best route for the patient and doctor is to send patients to pedorthists who specialize in customizing ready-made shoes and custom shoes for Charcot and other deformities outside the available ready-made shoes on the market. The American Board for Certification in Pedorthics and Pedorthic Footcare Association are resources to help find skilled career pedorthic professionals and custom shoemakers.


 


Robert S. Schwartz, CPed, Eneslow Shoes

02/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Double Board Success at WesternU


From: Lester Jones, DPM


 


I want to send congratulations to the members of the WesternU College of Podiatric Medicine Class of 2019 who recently learned that they achieved a 100% pass rate on both the APMLE Part 2 written exam and the Clinical Skills Performance Exam. This stellar outcome represents the diligence and hard work that are hallmarks of the students at CPM. You are a class apart!


 


This is the second year in a row that the fourth-year class has scored 100% on both of these board examinations. The College leads the nation in residency placement as well as with a five-year history of 100% placement of all graduates into some of the best hospitals in America for their three-year residency programs.


 


I also want to thank the WesternU community of faculty and staff who work hard to make this College and University such an outstanding place for learning. Strong work all.


 


Lester Jones, DPM, Interim Dean, WesternU College of Podiatric Medicine

01/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Dan Klein, DPM


 



When will podiatrists realize that having a DPM license will never allow you the privileges of your counterparts in the MD/DO arena. It doesn’t matter how many courses or certifications of training in marijuana dispensing you take, at the end of the day, you are still a podiatrist. I have advocated and others have advocated for getting a dual license DPM and MD/DO license. Until the schools offer an avenue to obtain these licenses, podiatrists need to recognize their limitations. MD/DOs rule the land! Final word. 


 


Dan Klein, DPM, Fort Smith, AR


01/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Tip Sullivan, DPM, David E Gurvis, DPM


 


Where did Dr. Gary Smith get his data regarding the ill effects of chronic marijuana use? I could not find convincing data to support his claims or assumptions as to the results of chronic pot use. Dr. Smith brought up an ethical debate regarding the legitimate use of marijuana for medical conditions (medical marijuana). If marijuana is prescribed for legitimate use in approved medical/ podiatric conditions, to assume that it is unethical to use makes no sense to me. Like opioids, the problem is when physicians over-prescribe or prescribe them for illicit use. I would say that is the ethical issue here lies not in the drug itself but in the way it is used by the persons prescribing it. 


 


Disclosure: I am a 63 y/o male and went through a "chronic pot phase" in high school and college. 


 


Tip Sullivan, DPM, Jackson, MS


 


With all due respect to Gary S. Smith, DPM, his letter is not filled with one verifiable fact or known effect of marijuana. "Marijuana is a 'gateway' drug … marijuana causes diabetes, neuropathy, and renal failures!?" He cannot back up even one of these statements with medically accepted fact. If he can, please do. Otherwise, make it known in advance that these are your beliefs, and not medical facts.


 


Yes, there truly are some downsides to marijuana. Several to be exact. But not one you stated is any more than a myth or a belief you hold. Additionally, if a patient had depression, no, marijuana often would not make them feel better (as a rule of thumb but if medical intervention had failed, and it did, who are you to take that away from someone?), and if they had terminal cancer, then personally I wouldn’t care even if all your misstatements were true.


 


David E Gurvis, DPM, Avon, IN

01/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Gary S Smith, DPM


 


I realize this is a controversial subject with many points of view. I am not against the legalization of marijuana. I do believe that doctors and users need to be better educated because any view that comes across anti-pot seems to be a source of contention. First of all, there is no such thing as "medical marijuana". Any ailment you have from terminal cancer to depression and pain, marijuana will make you feel better. 


 


Snorting coke, shooting heroin, and over using opioids will make you feel better as well. This doesn't mean...


 


Editor's note: Dr. Smith's extended-length letter can be read here

01/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Dia McCaughan, DPM


 



I actually took the 4-hour certification course for this at my local hospital, for a fee. Afterward, I logged onto the PA Department of Health and the medical cannabis website to register my practice with the Commonwealth. It was then that I discovered I was not permitted to register since I was not an MD/DO.  


 


I comprised a thorough letter to my local representative, who is now the Speaker of the House of PA, discussing the issue why podiatry should be included and the qualifying conditions we manage on a daily basis. He responded immediately, agreeing with me, and stated he would look into it. Three weeks later, I received a call from the PA Department of Health, letting me know podiatrists cannot register at this time, and no expected approval date has been set. So, back to square one again, I suppose. 


 


Dia McCaughan, DPM, New Providence, PA


01/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Ira Baum, DPM


 


Dr. Udell presents an interesting point regarding the validity of research and acknowledging the documentation of its authors. My understanding is that he believes authors' credentials in some way demonstrate a bias and that it’s irrelevant to the quality of the research and its use. He is correct in logic, but not in his conclusion. Research that results in quality information is not dependent on its authors is true, but readers and users of the research should be entitled to know the background of its authors. Research is an ongoing process and therefore most authors with an education and knowledge in the field have an in-depth, historical understanding of their subject matter and may have insight that a novice may not have. I’m not saying that having a degree is required for quality research; I’m saying it adds a degree of confidence to the reader/user, not a necessarily a bias.


 


Ira Baum, DPM, Naples, FL

01/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Michael Levi, DPM


 


I agree with Dr. Ornstein concerning the teachings of practice management in the curriculum at our schools. Unfortunately, when I spoke to [the administration at] Western College of Podiatric Medicine, the school responded that there is no space in the curriculum. I realize academic and clinical skills are paramount to our students; however, I feel these practice management skills are necessary to our students. Many of our young doctors have large debts, and management skills are necessary. I think business and management skills can be taught in a seminar format to fourth year students or residents. Even if a young doctor practices in a VA, at Kaiser, or in a corporate-type of setting, these skills are still usable. They are not germane just to private practice.  


 


Michael Levi, DPM, Santa Monica, CA 

01/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Scarlett Kinley, DPM


 


Liquid Rubber Appliance Laboratory (manufacturer of latex shields) of West Orange, NJ is an “old school” business still making this good device for high pressure and high-risk bone prominences for patients needing or desiring to avoid surgical treatment. They make several devices for nine areas of the foot. They send a paper invoice with the device and the positive cast; payment is by check only, I believe. 


 


Scarlett Kinley, DPM, Clearwater, FL

01/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven J. Kaniadakis, DPM


 


This also seems to be a trend among other generic medications. Try writing as Merpergan Fortis. Although the two are essentially the same, some generics, even brand names, are sending limited to no supplies to pharmacies. For another example, CVS and several pharmacists reported that the manufacturer company named Mylan is not providing its generic supplies of some medications it typically delivers. 


 


Steven J. Kaniadakis, DPM, Saint Petersburg, FL

01/14/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Charles Lombardi, DPM


 


1) Half of the dues Dr. Kass speaks of does not go to NYSPMA; it is in-actuality APMA dues we collect for them. 


2) The NYSPMA does NOT have sponsored speakers for lectures. The lectures are based on current areas of interest.


3) NO board member of the NYSPMA gets paid a dime from the Association or dues to meet numerous times a year at great personal expense.


4) NO board member of the foundation gets paid a dime to spend numerous hours coordinating the conference, meeting with legislators and insurance companies to help members and non-members advance the fight for their rights and the podiatry profession as a whole. Members get the conference credits for free because all these things COST MONEY.


 


Finally, Dr. Kass reminds me of the football fan sitting in the bleachers with a green face, yelling that the players are just bums who don't know what they are doing. He doesn't even have the courtesy to sit on the bench and pay his dues. He yells from the bleachers but benefits from the work the NYSPMA does on advocating on his behalf. 


 


Charles Lombardi, DPM, President, The Foundation for Podiatric Medicine


 


Editor's note: This topic is now temporarily closed.

01/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Allen Jacobs, DPM


 


Dr. Kass suggests that “most” podiatrists who are NYSPMA members are so only for access to CME credits. One wonders on what factual basis Dr. Kass draws this conclusion. Has he personally conducted a survey of the membership? 


 


There are many benefits to APMA membership. While I hold strong personal disagreements with some APMA policies, ultimately, they represent my profession. They are in effect my union. We, as a profession, cannot afford nor withstand divisiveness. If the only reason for membership in the APMA is to access CME credits, it is less expensive not to belong to the APMA, and satisfy the CME requirements while paying the increased "non-member fee." 


 


Finally, an observation from someone who has invested years of work and lost income and family sacrifice in both the APMA, ACFAS, and has "been around the podiatry block" for many years. The current NYSPMA leadership is as good as I have ever witnessed. In my opinion, the dues money spent by members is well spent. Yes there are problems. The NYSPMA leadership has been addressing those problems. The NYSPMA has also been proactive in identifying the future needs of its membership and working on those needs in order to protect the future needs of our patients and our profession.


 


Allen Jacobs, DPM, St. Louis, MO

01/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From:  Ken Meisler, DPM


 



I agree with Dr. Kass that the NYSPMA meeting is not really "free" for members but paid for by our dues. However, I disagree with Dr. Kass saying that most people belong to the NYSPMA because they see value of getting their CME in one weekend. We belong to our state societies and the APMA because these are the groups that fight for us at the state and national level. Without these societies, I think we all know that we would be much worse off. A great example is the recent proposed changes in Medicare E&M codes that the APMA stopped from being implemented. 


 


The NYSPMA annual meeting is much more than just "getting your CME in one weekend". Nowhere can you see so many podiatry exhibitors in one place. Seeing many of these same companies on line is not the same. Plus, being around thousands of podiatrists is an exciting and informative experience and only possible at a few meetings a year. 


 


Most importantly, we should ALL join our local and state societies. Those of us that are not members benefit from the hard work of those groups. However, they also miss out on a lot of benefits they could get. If more people joined, the dues would go down also. Your state and local dues are monies well spent.


 


Ken Meisler, DPM, NY, NY


01/03/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Payment Disparity Between DPMs and MDs


From: Jeff Kittay, DPM


 


Though I have been out of practice for more than three years, I do read PM News regularly and am thrilled that I no longer have to deal with the myriad governmental intrusions and regulations that active practitioners must endure in attempting to make a living. That said, the argument made in several recent letters regarding the “payment parity” issue existed before I went in to practice in 1979 and apparently persists. No DPM, no matter how good his/her training, will ever receive the same payment for the same billed level of service as MD/DO trained physicians, and they should stop dreaming about “parity”. 


 


Until the degree students receive says MD/DO, insurers will assume, right or not, fair or not, that the level of training and expertise is NOT equivalent. How many DPMs are expert at...


 


Editor's note: Dr. Kittay's extended-length letter can be read here.

01/02/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Payment Disparity Between DPMs and MDs


From: Tom Silver, DPM


 


It's sad to hear the responses to my initial post regarding MDs across the board getting paid a lot more for new and established office visits than the same visit codes I submit as a DPM. There had been a lot of prior discussion regarding when to use a level 3 or 4 visit for patients, but it still doesn't make much difference when MDs are getting up to 3 times what we get for every office visit!  


 


I did an analysis of insurance payments on all office visit codes for 2018, and we were paid approximately $95K for visits. And MDs would have been paid up to an additional $190K more for the same visit codes!  This is no small difference, especially for a solo practitioner and would really add up for group practices!


 


I don't think we can "just accept this because we don't have an MD degree" or are part of a large group that can negotiate fees. Hopefully, the APMA and state associations can work together for us to by putting the "group practice" pressure on insurance providers that is needed to change this gross discrepancy and gain some payment parity for us!


 


Tom Silver, DPM, Golden Valley, MN

12/29/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B


RE: Payment Disparity Between DPMs and MDs


From: Dan Klein, DPM


 


I have read from many podiatrists that they are upset about the difference in pay by insurers. When will podiatrists realize that as a podiatrist, you will never share the same turf as our counterparts and therefore not be recognized as such. Podiatrists have and will always be classified as allied health providers. Until MDs and DOs cannot provide our services, you will never see us providing a unique service. We will gladly be accepted into hospitals for our services, but the patient is not classified as a podiatry patient versus a medical patient. The reimbursement rates to the hospital are the same.


 


If you are unhappy with the podiatry reimbursement fees, you must get an MD or DO degree. This appears to be the only avenue open to us for equal pay! This is our future, love it or leave it!


 


Dan Klein, DPM, Fort Smith, AR

12/29/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B


RE: Payment Disparity Between DPMs and MDs


From: Ira Baum, DPM


 



When I founded and participated in a podiatric LLC,  Florida Foot and Ankle Associates in the early 2000s, two fellow board members and I had the opportunity to meet with the president of one of the major healthcare insurance companies. At the meeting, we were given a lesson in rudimentary business practice, supply and demand. There we learned about a podiatrist’s place on the ladder of importance of our service compared to other specialties. 


 


Due to our position, negotiating improved reimbursements was not successful. Pleading our case based on our cost-saving quality of care, even offering an internal review committee to ensure the objectives, fell on deaf ears. Even adding in the concept of critical mass did not move the needle. Maybe things have changed for single specialty podiatric groups, but even if they have succeeded, unless all podiatrists are positively impacted, it does nothing to improve the podiatric profession as a whole and, in fact, will fractionalize it over time. In other words, the key to success of large podiatric groups is inclusivity, not exclusivity. Bad apples will be identified quickly and easily, and they will learn to conform to standards or be excluded from the group.


 


Ira Baum, DPM, Naples, FL


12/29/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Jeffrey Kass, DPM


 


Dr. Hamilton’s story of his medical group’s ability to demand a higher payment for him no doubt occurred because of the “threat” of the group at large withdrawing from the particular insurance plan. I have never heard of an insurance company caving in to a solo practitioner. I agree with Dr. Hamilton that there is power in numbers, but I also believe that each CPT code should be paid the same rate to whomever is doing the procedure.



 


It is just wrong for Dr. X from a large group to get paid a higher rate than Dr. O the solo practitioner for the same exact CPT code. When I was a member, I brought this up at a state society meeting. The response given to me by the president was that I needed to negotiate a better contract. Out of curiosity, has any solo practitioner colleague had such success and is willing to share their secret? I thought equal pay for equal CPT was a worthy fight for the profession, and medicine at large.  


 


Jeffrey Kass, DPM, Forest Hills, NY, Forest Hills, NY


12/27/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Payment Disparity Between DPMs and MDs


From: Jarrett Hamilton, DPM


 


12 years ago, I was fresh out of residency and chose to join a multi-specialty group. As part of the credentialing process, my new group was trying to get me on the Humana panel in our community. At first, I was told flat out “we have enough podiatrists. We don’t need/want you.” -  to which our group said all or nothing! (Meaning they threatened to pull all the other physicians in our group if I wasn’t credentialed).  


 


Humana caved in and tendered me a contract. Unfortunately, the contract tendered was at below Medicare rates of reimbursement (All the doctors in our group got 115% of Medicare from Humana). So once again, our CEO said, "if you want any of our doctors, you will pay all of them at 115% of Medicare." They once again caved in to our demands. To me, this experience highlighted the need to be part of a larger organization early on in a career.   


 


Jarrett Hamilton, DPM, Sierra Vista, AZ

12/26/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: 10 Rules for Reducing Non-Traumatic Amputations in Diabetics


From: Allen Jacobs, DPM


 


1. We cannot stop non-adherence of diabetics in preventive foot care. As podiatrists, we can educate, we can advise. We cannot enforce. Non-compliance is the number one cause of amputation.


 


2. Many patients cannot afford indicated therapies, from office visit co-payments to emollients, from deductibles to oral medications. 


 


3. Amputation reduction should be an ongoing process, not restricted to once yearly...


 


Editor's note: Dr. Jacobs' extended-length letter can be read here

12/26/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Jeffrey Kass, DPM


 


Dr. Rettig - larger groups getting paid higher rates due to bargaining power over a solo practitioner may not just be a bummer, it may violate Sherman Antitrust Law. Railroads used to monopolize businesses due to their “bargaining power”. Is this really any different? 


 


The argument “they negotiated a better rate” doesn’t seem plausible to me when there are no solo practitioners with the same rate. On the surface, this seems highly illegal. The issue in my mind is the lack of any form of “protection” we have within this profession. 


 


Jeffrey Kass, DPM, Forest Hills, NY

12/25/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Elliot Udell, DPM


 


Kudos to Dr. Jacobs for apprising us of the ADA's recommendation for an annual diabetic foot examination.


 


Many patients come to our office for this annual evaluation, and in most cases are sent by their family doctors. The problem is that there is no clear consensus among podiatrists as to what should constitute a diabetic foot examination. At an executive board meeting of the American Society of Podiatric Medicine, we once discussed what should constitute a diabetic foot examination. When discussing just the vascular portion of the exam, opinions ranged from some saying that all that is needed is to palpate pulses and manually test capillary return, to others saying that plethysmography and Doppler studies must be included. The only consistency was that each doctor felt that his or her protocol was the right way to do it and any other way was wrong. Each participant was not only in private practice, but was in some aspect of podiatric academia.


 


Because of the ADA recommendations and the fact that people are coming to us for diabetic foot exams, perhaps the APMA could conduct a study and clearly define what tests should and should not comprise a routine diabetic foot examination.


 


Elliot Udell, DPM, Hicksville, NY

12/24/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Desmond Bell, DPM


 


Thanks to Drs. Levy and Jacobs, et al., in their recent letters, for calling attention to several issues surrounding the increasing number of non-traumatic amputations occurring in the U.S.


 


We have an aging population, and most importantly, the number of diabetics in our country (and pretty much everywhere else) continues to increase. During my first year of residency, 1995-96, there were approximately 16 million diabetics among our population, whereas we are now at approximately 30 million. While the amputation rates may have gone down for a sample of time, the present upsurge in amputations should not...


 


Editor's Note: Dr. Bell's extended-length letter can be read here.

12/21/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Estelle Albright, DPM


 


First, let me say that I entirely agree with Dr. Jacobs’ post. There are other factors that are important in preventing amputations:


 


1. The fact that virtually every packaged, prepared, canned and fast food item contains sugar. Labelling as to actual sugar content is hidden by manufacturers by listing ingredients in descending order with highest first, BUT, they list the various sugars each separately, instead of as sugar. Examples: High fructose corn syrup, glucose, mannose, fructose, ...


 


Editor's note: Dr. Albright's extended-length letter can be read here.