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From: Estelle Albright, DPM


I am surprised from the survey that so many podiatrists are still grinding nails. To those podiatrists who are still grinding fungal toenails: Please consider the considerable risks to self and staff caused by nail grinding: lung granulomas, and fungal sinus or lung infections caused by aerosolization of fungal nail particles or spores. Also, consider the risk to staff for cleaning, disinfecting, and sterilization procedures of re-usable burrs.


I am of the opinion that we, as physicians, should instead treat the infection medically or surgically. There are many safe oral and topical antifungal meds available, as well as surgical treatment of fungal nails. If none of these are an option, consider double action bone cutters to debride thick nails. These do a very decent job on thick, hard nails and are easier on your hands. For ingrown edges, Miltex 40-22A ultrafine nail splitters are excellent for simple nail edge avulsions.


Estelle Albright, DPM, Indianapolis, IN

Other messages in this thread:



From: Harvey F. "Bunny" Brown, III, DPM, Ivar Roth, DPM, MPH


The term we use here in Arkansas is: podiatric physician and surgeon. 


Harvey F. "Bunny" Brown, III, DPM, Little Rock, AR  


To avoid confusion, I now say I am a podiatric foot and ankle surgeon. I did three years of a surgical residency so I think that is a fair description.


Ivar Roth, DPM, MPH, Newport Beach, CA



From: Ivar E. Roth DPM, MPH


I would like to take exception to Dr. Harvey’s comments about Saturday office hours. I too did not have Saturday office hours(for over 30 years), until recently. My kids are off in college now and I decided that I wanted to expand my practice.


The only practical area for growth was to open up Saturdays, which I decided to do. Patients LOVE the convenience and it is our “casual” dress attire day. It is a big hit and I plan on opening up Sundays also now. Of course, I cannot work 7 days a week and I do not plan to. It will be a great opportunity to hire some younger practitioners who are eager to work and improve their finances. I see this as a win/win for everyone. I am curious as to how many  other practices out there are open on Sunday?


Ivar E. Roth DPM, MPH, Newport Beach, CA



From: Joel Lang, DPM


It is interesting that the current poll concerns Saturday hours. When I first started out, I did have hours on Saturday morning 9 AM to 1 PM. I think this is helpful for any new practitioner with lots of debts and bills and not so many patients. 


However, as my practice progressed, I gradually cut down on Saturdays. After a while, I worked only every other Saturday. Then the following year, I worked only one Saturday a month. The following year, I cut out Saturday hours completely. I think this is a good plan for any new practitioner in private practice as his/her Saturday patients gradually become adjusted to the new scheduling.


The best advice I got going into private practice was to "Practice on your first day the way you would like to be practicing 20 years from now, because it is hard to change once practice habits are formed."


Joel Lang, DPM (retired), Cheverly, MD



From: J. Scott Rosenthal, DPM


I agree with Dr. Roberts that attire is a personal decision and varies greatly with the locale and spirit of the office and patient population. I am admittedly one of those shameful podiatrists who dresses casually with slacks and a button down shirt. No tie, no white coat, no scrubs. Never have I had a patient question my attire, except for the few times when I happen to wear a tie for a meeting, when they often ask, "Why are you so dressed up?"    


J. Scott Rosenthal, DPM, Los Angeles, CA 



From: Narmo L. Ortiz, Jr., DPM


Once again, PM News visits the issue of what office attire our colleagues wear in the office. Nevertheless, when a colleague expresses his or her "feelings" on the issue in this forum, and blindly shames or belittles his or her colleagues for what attire they choose to wear in their office, it is very unbecoming and unprofessional. It speaks volumes about the person who claims to be a "professionally dressed" doctor.


Narmo L. Ortiz, Jr., DPM, Lakeland, FL



From: George Jacobson, DPM, David S. Wolf, DPM


My experience is exactly as Dr. Charles Morelli describes it but I still wear an embroidered lab coat over the scrubs.  We also pay for the staff's uniforms (embroidered scrubs ). I let them pick matching colors that they coordinate on different days of the week and with holidays. 


George Jacobson, DPM, Hollywood, FL


In my experience, patients don’t care how you are dressed or how much you know; they want to know how much you care.


David S. Wolf, DPM  (Retired)  Houston, TX



From: Jerry Roberts, DPM


Physician attire is a regional decision. I’ve practiced in areas where wearing a tie is a requirement and the absence is considered unprofessional. I’ve also worked in areas where scrubs are worn by many and wearing jeans with or without a lab coat is common. The primary focus is establishing trust with your patients while delivering the care they need. Any attire that detracts from this goal, whether it’s too formal or too casual or otherwise inappropriate, makes quality care more difficult to deliver. 


Jerry Roberts, DPM, Somerset, KY



From: Charles Morelli, DPM


When I first got into practice 28 years ago, I wore slacks, a dress shirt, tie, a new lab coat and $200 shoes. After the first year seeing my dry-cleaning bill soar into the thousands of dollars, I quickly changed how I dressed. If I was a primary care physician who did nothing more than check my blood pressure, listen to my lungs, look in my ears, etc., and then call in his nurse to do everything else, I too might dress in a shirt, tie, and a lab coat. In my practice as with many of us, I am continually exposed to not only wounds and bodily fluids, but also things like Betadine, silver nitrate, and gentian violet that can turn an $80 pair of slacks in to garbage (not to mention the shoes). The PCP does not, nor does any other doctor who does not do what we do.


I now wear clean, professional scrubs, embroidered with my name as well a crisp lab coat. I never dress “casually” as if I am going to leave and rush to my second job at Walmart. When I had my kidney transplant and met the man who was going to save my life, I assure you I didn’t care how he was dressed; or she for that matter. He walked into the room in scrubs and his hospital issued lab coat was professional, and he proceeded to take my history. Quite frankly, it was a comfort to see my surgeon dressed as a surgeon.


Charles Morelli, DPM, Mamaroneck, NY



From: Alison Silhanek, DPM


Professional versus “casual” dress. I just don’t understand this argument. I have been in practice 20 years, so perhaps I can now be considered old and out of touch. I have seen the general trend in U.S. dress towards very casual. Adults wearing pajamas when buying groceries. But I was surprised at the percentage of PM News respondents who listed that they dress casually for work. The highest percentage was those respondents who wear scrubs to work.


As a surgeon, I suppose I understand that, though I wear professional clothes in the office. As a woman, I feel that no woman, regardless of body type, looks good in scrubs, but maybe that’s just me. Regardless, I see my primary care physician and cardiologist and they wear professional attire. Why should we as podiatrists dress less professionally?. And for those who voted that they dress “casual”? What the heck is that? Are you now working as a teller at Walmart? For all your schooling and residency, you dress casually? Shame on you. Have some dignity and pride in being a doctor. Period.


Alison Silhanek, DPM, Smithtown, NY



From: Dan Michaels, DPM


We have banned all forms of grinding of nails. We use Miltex double-action nail nippers with straight jaws for debriding nails. These are very similar to double-action bone cutters. Patients are satisfied with this. You can get the thickness and the length with this method. You don't put yourself at risk of inhaling any irritants this way, and you can sterilize (with autoclave) your instruments when done. I published my instrument preparation protocol in PM News (and in Podiatry Management Magazine) a few years ago.


Dan Michaels, DPM, Frederick, MD



From: Elliot Udell, DPM


When literature out of England came out many years ago showing that podiatrists who grind mycotic nails were at risk of developing pulmonary problems, I took all of my drills and tossed them in the pail. Being an allergy sufferer, even the expensive vacuum systems did not prevent me from wheezing after doing a nail grinding.


How did my patients react to this change? Some left for other podiatrists, but most stayed. I explained to them that not only will they be breathing in their own mycotic nail dust, but they will be breathing in the infected dust from every other patient we saw in the last 12 hours.


I also believe that there are OSHA laws that require that a treatment room be left unused after grinding infected nails for a period of 8-12 hours. This makes sense and I do not regret not grinding toe nails. We all took the oath to help and do no harm, and grinding mycotic nails dances on the border of violating this oath.


Elliot Udell, DPM, Hicksville, NY



From: W. David Herbert DPM,JD


Well over 20 years ago, I was appointed to the committee of podiatry examiners for the state of Wyoming. I was really surprised at the lack of knowledge about basic anatomy and biomechanics some of the examiners demonstrated. Some of these podiatrists had completed several years of residency training. If a lower pass rate on the board exam will mean that only better prepared individuals will obtain hospital privileges, I believe that this will ensure that the podiatric profession will be more widely accepted as the foremost authority on the treatment of the foot and ankle.


W. David Herbert DPM, JD, Billings, MT



RE: Will eliminating the ACA mandate help podiatry? (Joel Lang, DPM)

From: Bryan Markinson, DPM


Dr. Lang seems to intimate that it is obvious that podiatry as a profession is better off with the ACA mandate requiring the purchase of health insurance. I am not so sure. My vantage point is from an academic medical center-based practice which is a full-time private practice and a part- time hospital clinic practice. The private SPECIALTY practices largely do NOT participate with most plans offered on the health exchange, which is also true of most of the community-based podiatrists (this is a supposition that I cannot verify). 


The specialty clinics largely do participate with the exchange plans, which seem to be nothing more than...


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



RE: Will eliminating the ACA mandate help podiatry? (Joel Lang, DPM)

From: Judd Davis, DPM


I must respectfully disagree with Dr. Lang's assessment of the ACA. Since he is retired, I suspect he is not seeing the reality of the ACA in a private practice setting. I am one of the 34% who feel the ACA has been a massive failure for the following reasons: 


1) Most of the ACA plans have huge deductibles, essentially providing catastrophic coverage only. Many of the people who sign up for these plans are completely unaware of this and surprised to find their entire...


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



From: Joel Lang, DPM


In a recent PM News Quick Poll questioning if podiatrists would be better off without the Affordable Care Act, I was astounded to discover that 34% thought they would be better off and another 27% were unsure. 


Without the ACA, the Congressional Budget Office, a non-partisan governmental agency estimated that 13-26 million people will lose their health insurance. The currently debated tax bill has been rated by the same agency to increase premiums by 10% and result in...


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



From: Robert Scott Steinberg, DPM


What positive change would the elimination of the ACA bring for a podiatrist in practice? I really would like to know.


Robert Scott Steinberg, DPM,  Schaumburg, IL



From: Adam Siegel, DPM


Maybe I am young and naive, but can someone please explain why paper charting is better than an EMR? A properly organized and implemented EMR can save a practice thousands of dollars a year (even after taking into account the costs for the EMR). Jon Hultman, DPM's book The Medical Practitioners Survival Handbook should be required reading for anyone still using or wishing they were still using paper. Pay close attention to chapter three where he gives you hard numbers on how much money you can save (hint: it's a lot).


Adam Siegel, DPM, Lutz, FL



From: Lenny La Russa, DPM


I prefer EMR. I can make a more comprehensive note in a fraction of the time dictating into SamNotes with Dragon Dictate. It is also easier to comply with MIPS.


Lenny La Russa, DPM, Americus, GA



From: Richard M. Adams, DPM 


For the past three years, I have been using a company based in Little Rock, AR called MedOptim. They are a remote, electronic-based scribe service so there is no need to have another person crowding the exam room. They enter all pertinent information directly into my EHR and are literate in many, many different EHR formats. My only responsibility is to review and proofread/sign my notes. The service is fantastic!  Not only have they made my life easier, but they remind me when I forget to "dictate" certain aspects of the patient encounter, thereby adding another layer of accuracy to my notes. They are highly recommended.


Disclosure: I have no financial interest in MedOptim or any surgical scribe service.


Richard M. Adams, DPM, Granbury, TX



From: Paul Kesselman, DPM


Last week's poll on proper HCPCS coding definitely illustrates the need for greater education for all orthotic providers. I agree with Dr. Blanken that despite the many court battles (even more than the California case cited by Dr. Blanken) in defending the use of L3000 (all of which we have won), there appears to be a general absence of knowledge of over 25% of those brave enough to respond to this poll. That is, more than a quarter of our colleagues are unaware of the correct code to use, with greater than 5% of the opinion that L3030 (custom fitted orthotic) is the correct code. 


For those unaware, L3030 is the code used to describe a pre-fabricated device which is then...


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



From: Steven Selby Blanken, DPM


It is amazing to see that 16% of the profession use the wrong code for foot orthotics. Most of us know about the problems years ago that happened with Blue Cross of California with trying to retract money for the L3000 code. They eventually lost and had to pay back all the podiatrists. Most podiatrists who dispense proper foot orthotics should be using the L3000 code for each foot.


Steven Selby Blanken, DPM, Podiatry Consultant, Performance Laboratories



From: Joel Lang, DPM 


In the last PM News retirement plan survey, I noted that about 11% of podiatrists have no retirement plan. That is really bad – and it’s all in the “thinking”. 


I suspect the majority of those 11% are new practitioners who either think they can’t afford to put money away at this time because of their low income and high student loans, or those who are short-sighted and think that the need for retirement funds 30-40 years down the road is not...


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



From: Ken Malkin, DPM                              


As a delegate to the APMA House of Delegates, I actually asked for the straw poll from our delegates. There was no deep thoughtful discussion before the vote, just a number of events that occurred during the meeting making it clear that the 4-4-3 year model of training young podiatrists should lead to a more enhanced scope of practice. My first comment to those 10% who voted against a name change was that they were a bunch of dinosaurs.


One young bright New York delegate, Andy Shapiro, said he was one. Since then, I have heard many more opinions against the name change that I think have merit. On Thursday, APMA sent an email to its members explaining that a long process was planned before anything is POSSIBLY proposed. So stay tuned.  Sorry, I was wrong and caught up in the moment. 


Ken Malkin, DPM, Boynton Beach, FL



From: W. David Herbert, DPM, JD,  Eric J. Lullove, DPM


I believe the better way to go would be to change the name to "The American Association of Podiatric Physicians and  Surgeons (AAPPS)." There would be no restrictions on pursuing an expanded scope of practice because of the specificity of the name.


W. David Herbert DPM, JD, Billings, MT


While I can respect the need to eventually make a name change with regard to the American Podiatric Medical Association, I am not sure that the name change to the American Association of Foot & Ankle Specialists is appropriate. My recommendation to the APMA would be to take a page out of big business….hire a PR Firm to re-brand the APMA to something that will hit on social media, the Internet, marketing, and BRAND podiatrists to a degree and level that the AMA, AAOS, SVS, and other organizations have built.  


If we all learn one thing from the last presidential election — branding is everything. Messaging follows. If this is the best name we can come up with, fine, then run with it. Otherwise, walk the name back and figure out a better name to rebrand ourselves. 80% of Americans own a smartphone. Do the math. If someone is looking for a DPM, most bets would be it is on their smartphone. Brand the APMA to something that is easily searchable, readable, and palatable.


Eric J. Lullove, DPM, Boca Raton, FL



From: Brian Kiel, DPM


There is no medical specialty called foot and ankle specialists. There are podiatrists and orthopedic surgeons who specialize in the ankle as well as the foot, but no school gives a degree in the foot and ankle. This change completely eliminates the word that defines who we are. Now, if the desire is to mask who we are and pretend to be something we are not (hint-hint), then this might work, but I am a podiatrist and want to be known as one. Thirty or forty years ago, the general public was not as familiar with the word podiatrist, but now not only they but the medical profession knows us as such.


We get MD referrals who tell their patients that they need to see a podiatrist, not a foot and ankle specialist. If we become foot and ankle specialists, what is to separate us from orthopods? Nothing. We are podiatrists; we treat the foot and ankle in various ways and the constraints of what we can do is often limited by law. All of us are not ankle surgeons, and to imply that we are is not good for the profession. What we do, we do well. No other profession comes close. Let’s not hide who we are.


Brian Kiel, DPM, Memphis, TN

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