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07/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Preventing Suicides of Podiatric Residents


From: Patrick DeHeer, DPM


 


According to a recent study, “In the United States, approximately one physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing more than 4-fold during the first 3 months of an internship year. Despite this increase, to our knowledge, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. This study demonstrates that a free, easily accessible, brief [web-based cognitive behavioral therapy (wCBT)] program is associated with reduced likelihood of suicidal ideation among medical interns. Prevention programs with these characteristics could be easily disseminated to medical training programs across the country."


 


We created a survey based on the survey used by the St. Vincent internal medicine and family practice residencies to examine their residents' well-being. I believe the updated study is critically important. The podiatric profession can either continue to stick our heads in the sand on this topic or examine how it is affecting our future by helping to disseminate this survey. 


 


APMA has agreed to help get the survey out to podiatric residents, and I hope your various organizations will join APMA's efforts to examine our own profession. I will be using my bully pulpit to get the word out. I hope we can help to disseminate our survey to the podiatric residency community. We plan to collect the data and present it to key stakeholders to hopefully develop a podiatric-specific wBCT. 


 


Patrick DeHeer, DPM, Indianapolis, IN

Other messages in this thread:


10/26/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: An Open Letter to the Council on Podiatric Medical Education


From: Lee C. Rogers, DPM, et al.


 


It's Time to Finally Make Wound Care a Mandatory Part of Podiatric Medicine and Surgery Residency Training.


 


Dear Council on Podiatric Medical Education (CPME) Residency Ad Hoc Advisory Committee, As you are completing the arduous task of the required periodic review and revision of CPME Document 320,1 the Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies (PMSR), we wish to applaud your efforts on the advancement of podiatry residency training standards over the decades. Today’s podiatrist is well-trained in surgery because of your actions and those of other CPME committees to ensure the standards are being followed. However, there remains one glaring omission from the PMSR training in Document 320, last revised in 2018.


 


Where is wound care? Please note our preference would be to refer to the topic as “tissue repair and wound healing”, since we don’t just care for wounds; we use a combination of...


 


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

10/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Jeffrey Toobin, Esq. “Clearly not a Foot”


From: Bret M. Ribotsky, DPM


 


I sit back today with the majority of our profession with a big smile,  It was a little over 10 years ago when the same Jeffrey Toobin from CNN and The New Yorker magazine published an article where he referred to podiatrists as “three steps below a dentist.” I took the opportunity to interview him on Meet the Masters in 2010.


 


During the 10 minute interview, he acknowledged that a podiatrist saved his mother's (a national CBS Reporter) life and was appreciative of our profession, but he was unwilling to retract or say he would do anything different if given the chance to do again. Thus, I was grinning from ear to ear at the news of him caught in the act of masturbation on a Zoom call. An anonymous source who was on the Zoom call said, “he clearly did not have a foot.” - Karma .


 


Bret M. Ribotsky, DPM, Boca Raton, FL

10/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Denis LeBlang, DPM, Nick Turner


 


There is a company in Los Angeles called Osada, Inc. They have the equipment that you need to drive the Shannon 44 burr. You will be happy with their equipment. 


 


Denis LeBlang, DPM, Congers, NY


 


Many physicians have opted to use the Osada Portable All-in-One PEDO-30W drill unit along with the Shannon for in-office MIS. DocShop Pro carries this unit and all other Osada units. Additional saw options are available as well to complement your Shannon.


 


Disclosure: I am the Vice President of DocShop Pro.


 


Nick Turner

10/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: If Falsely Accused - What Would You Do?


From: Martin R. Taubman, DPM, MBA


 


Friday, August 17, 2012 ended the week-long ordeal of one of the most damaging series of San Diego County fires in local history. Clouds of ash blanketed the city leaving an oily, gray residue on our cars, lawns, and streets for most of the week. People were evacuated from their homes; some homes burned to the ground. In fact, one of our fellow podiatrist’s home was lost to the fire and had to be rebuilt. People died. Lake Cuyamaca and its surroundings were devastated.


 


Driving through its prior verdant scenery was heartbreaking—the trees stood like broken, blackened skeletons amidst a barren, burned earth. The canopy of trees which covered miles of Highway 79 leading to the lake from Route 8 was gone. It was estimated it would take 100 years for the area to return to its previous pristine grandeur. I’ll never forget it.


 


However, there was another event that occurred that fateful Friday, and it will remain etched into my memory with at least the same vivid horror (or worse) as...


 


Editor's note: Dr. Taubman's extended-length post can be read here.

10/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: When a Patient Sexually Harasses An Employee


From: Elliot Udell, DPM


  


This past week, the Nassau County Podiatric Medical Association sponsored a lecture on dealing with sexual harassment issues. The main thrust of the presentation dealt with potential problems between employees and employers in the workplace as well as potential problems between workers regarding various forms of sexual harassment and discrimination. It was an excellent presentation by Mathew Feldman, JD and the Long Island team.  


 


Two years ago, one of my employees told me that one of my long-time male patients made some unacceptable verbal remarks to her of a sexual nature. There were no witnesses. My gut feeling at the time was to permanently "show the patient the door." I did let my employee know that what he said was totally unacceptable; however, since there were no witnesses, if I confronted the patient, would I not be opening myself and even my employee to a lawsuit? The patient could say in court that I falsely accused him and damaged his reputation, and since I was not there, I caused him pain and  embarrassment based on hearsay. I am certain that I am not alone and this has happened in other offices. How have others handled this problem?


 


Elliot Udell, DPM, Hicksville, NY 

10/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Medicare Advantage Companies Attempt to Game System by Overbilling CMS $2B (Paul Kesselman, DPM)


From: Ron Freireich, DPM


 


Here is from a post of mine on this very topic over two years ago. I start out by saying, "What a crime!" In it's simplest terms, it's called fraud. When a provider commits fraud of this magnitude, they are fined and thrown out of the Medicare system for life. If you read the OIG's 45-page report, their recommendations are basically a slap on the wrist as Dr. Kesselman points out. These insurance companies are trying to make patients look sicker on paper solely for their financial gain. These audits do not benefit the patient, the physician, or the medical system in general but are a continuous burden on our practices. These insurance companies should be held accountable like anyone else that commits fraud. What advantage are these advantage plans anyway?


 


Ron Freireich, DPM, Cleveland, OH 

10/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Tim Shea, DPM


 



Unfortunately, over the past number of years, I have been seeing an increasing number of patients who act out inappropriately to staff. Having practiced for greater than 45 years, it used to be very infrequent that I would have to deal with this. Now is a different story. I don't know the reason: Entitlement? Poor social behavior habits? The reality is that this type of behavior creates a hostile environment for the office .


  


Recently, a seminar in California listed all the reasons why you can be fined for "hostile environment" by the state, and I don't know if this is one of them, but I prefer not to take the chance. So if this kind of behavior is reported by staff to me or to the office manager, out comes the well-constructed (by PICA) discharge letter of inappropriate behavior, and the patient is discharged immediately. There is no more grace period or any reason to discuss why it is unacceptable. Your staff demands your protection, and this is an example that you must set.


 


Tim Shea, DPM, Concord, CA


10/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Jack Ressler, DPM


 


There is a fine line in dealing with a rude patient. On one hand, you do have to respect the patient’s opinions. Probably more importantly, you have to go to bat for your staff if they are right. I had a very interesting experience in my office where my staff member was both right and wrong on two different occasions. The first incident occurred when a patient did not get their way when making an appointment and ended up calling my receptionist an idiot. This patient did come back to the office after apologizing. It took all of two minutes for the patient to rehash this incident and again called my receptionist an idiot. I proceeded to tell the patient to leave and never come back. This was done before treatment. I must admit, dismissing a patient like this from my practice felt great, and was the first and only time I ever did that.


 


The second occasion occurred when the same staff member left a patient who was in severe pain in the waiting room because they were early for their appointment time. This patient did confront me in private while in the treatment room. I assured the patient that I will discuss this with the staff member. Although she was wrong, I made the mistake of asking her to come into the treatment room to discuss the incident in front of the patient. She had no explanation for her reasoning. Later in private, I diplomatically explained to her why she was wrong. She obviously was not in agreement because three weeks later, she quit citing this incident as her reason. In most cases, your staff is generally going to be right and they must be defended against unruly patients.


 


Jack Ressler, DPM, Delray Beach, FL

10/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Judith Rubin, DPM


 



I have noticed that when I have been going to doctors’ offices over the past few years, I am also asked to put in a credit card that will be automatically billed for no show fees. Since we call all our patients one day before by phone and send a text, there is absolutely no reason for patients not to tell our office that they can’t make. Of course, there are certain circumstances we allow for like fever that morning, etc. It has cut down tremendously on no show patients. It even helps when patients have balances.


 


We always call and ask if they would like to use their credit cards on file or change their card. Some don’t want to give us a credit card on their paperwork. They are afraid we will bill them unnecessarily. My office manager’s comeback is “do you order things online?” Of course their answer is always “yes”. She says to them “I rest my case.” Note: There are some doctors who are only accepting cash and checks now because the rates on credit card charges are going up. 


 


Judith Rubin, DPM, Cypress, TX


10/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From:  Elliot Udell, DPM


 


I am a caregiver for my parents. This means taking them to a plethora of doctors. Many have signs saying that unless 24 hours notice of cancellation is given, there will be a charge. In my situation, between urgent care visits, doctors’ visits, and actual hospital ER and hospital admissions, we have had to miss many appointments. To date, none of the physicians we go to have "fined" us for missing appointments. If they did, we would have to choose a different doctor in the same specialty. 


 


Wearing the "shoe on the other foot", I am not thrilled when a patient does not show without notice, but we do not charge patients. We do keep a record of who tends to be a "no show" and if it is often, we will tend to "overbook" that patient knowing that there is a likelihood that the person will be a no show. 


 


Elliot Udell, DPM, Hicksville, NY

09/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Keith L. Gurnick, DPM


 


Some, but not all patients have little respect for doctors and your time and office space commitment to them. If you force patients to give you an upfront "scheduling" deposit on their credit card and then they do not show up, too many of them will send in a dispute to their credit card company who will almost always side in favor of the patient and refund the money you took as a deposit. Credit card companies almost always side with the cardholder. That is just the way it works, and it just isn't worth the time or trouble to do what you are suggesting.


 


If you want to charge for "no shows", then you should do it the old fashion way. Simply post your policy in your office reception room, and also include it with your new patient intake paper work and also any mailings to patients. Inform your patients in advance on the phone when they schedule, and enforce your policy by sending a reasonable bill for the "no shows" or late cancellations, and enforce your policy by collecting the money.


 


Keith L. Gurnick, DPM, Los Angeles, CA

09/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Cigna Policy on NY Regulatory Restrictions on Balance Billing For PPE


From: Steve Abraham, DPM


 


From Cigna: “Effective August 5, 2020, the State of New York implemented a mandate that healthcare entities, such as Cigna, are required to notify participating providers that they should not charge our customers any fees for protective personal equipment (PPE) that exceed that customer’s normal financial responsibility.


 


Accordingly, if such fees are charged, Cigna is obligated to recoup those fees on behalf of the customer. If you have charged a Cigna customer for any PPE-related fees, we request that you immediately reimburse that customer for any funds that exceed their normal financial responsibility.


 


If a customer notifies Cigna of balance billing for PPE by a participating provider, a complaint will be filed on behalf of the customer and a Cigna representative will contact the treating office to seek reimbursement.”


 


Steve Abraham, DPM, NY, NY

09/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jack Ressler, DPM


 


For many years, we’ve been purging x-ray film in our office, and we found less and less companies even wanting old x-ray film, let alone paying you for the silver content. The fact that a certified company would come out to our office and take the film for free and legally dispose of it was more valuable than rarely finding a company that would pay you for the silver content.


 


Jack Ressler,  DPM, Delray Beach, FL

09/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Source for Phenol? (Jane E. Graebner, DPM)


From: Mark Stempler, DPM, Jim Ricketti, DPM


 


I recently bought a large bottle of phenol only to find out that it is not considered medical grade. I then ordered a large bottle from Schein Medical.


 


Mark Stempler, DPM, Staten Island, NY


 


Why is anyone not using my Phenol EZ Swabs for P&As? A bottle of phenol does not last, and the cost versus the ease of Pheno EZ Swabs are a no-brainer.


 


Disclosure: I am the inventor of the Swabs


 


Jim Ricketti, DPM, Hamilton Sq, NJ

09/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert S. Schwartz, CPed


 


To accomplish your goal, consider adding a lateral flare and buttress to his/her footwear. High-tops work best. Lateral stability is hard to achieve even in an Arizona AFO unless there is extra lateral support. Elevate for equinus conditions. And don't forget about rocker-soles for limited sagittal plane motion. Shoe inserts play a big role, as well.


 


Robert S. Schwartz, CPed, NY, NY

09/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Pete Harvey, DPM, Howard R. Fox, DPM, Carla Ross


 


I have always had my local pharmacy mix fresh 88% phenol which I replace every 2 months. The solution should always be almost clear and not yellowish.


 


Pete Harvey, DPM, Wichita Falls, TX 


 


Fisher Scientific has 99% phenol crystals in bottles of 100g or 500g. You’ll need to fax them your state license and a letter on your letterhead of your intended use. It ships by freight (corrosive).


 


Howard R. Fox, DPM, Staten Island, NY


 


Phenol can be ordered directly from Medisca:


 


MFG Item # Item Description Pack Quantity Price


38779193805 PHENOL LIQUID USP (LIQUEFIED) BO 100 $12.35


38779193808 PHENOL LIQUID USP (LIQUEFIED) BO 495 $34.40


 


Carla Ross, Talar Medical

09/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Elliot Udell, DPM


 


Not having to travel for seminars and not having to rent space for seminar conference space, paints a rosy picture of all of us paying less for our continuing education seminars. Having just attended and lectured at a virtual seminar, I can vouch that as a participant, I was able to hear the speakers better than had I been to an in person seminar. I was also more comfortable sitting in the chair I am now sitting at than some moldy chair in some far away hotel. 


 


There is, however, another side to this issue. We are all linked in our economy, and hotels - even resort hotels - are dependent upon convention business to survive. If  post-COVID-19 conventions find that Zoom or "Go To Meetings" seminars make more sense than live seminars, we can expect many resorts to go under in the years to come. 


 


Elliot Udell, DPM, Hicksville, NY

09/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Dale Feinberg, DPM


 


As Dr. Sherman pointed out, in the future, online conferences will have no travel costs associated with them. Since the principals will not have associated costs to produce the seminars, I expect the costs of their seminars should be reduced by at least 50%. We will all remain safe and the monies we all save can be spent when everything opens up again at the bar.


 


Dale Feinberg, DPM, Yuma, AZ

08/31/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Ivar E. Roth DPM, MPH


 



Dr. Stephen Epstein has a good idea... why not allow the taped version of a conference to be accessed online anytime for CME credits?


 


For us who sleep eat and breathe podiatry, we need afterhours and weekend access.


 


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


08/31/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Dock Dockery, DPM


 


After running several 3-day full length continuing medical education webinars this year with the International Foot & Ankle Foundation, I can’t tell you how many podiatrists recently have whined about the fact that they have to sit through hours of virtual lectures, or how hard it is if they still have patients to see, or that it is difficult to get up early or stay up late (due to time zone differences), or why can’t they just pay and get the CME hours without having to attend the sessions. 


 


I realize that virtual medical meetings are different from the live ones that we’ve always known. I also know that many doctors sign up for the educational meetings and then spend most of their time in the exhibit hall, out in the corridors visiting with friends, or by the pool or beach, or even in the meeting facility restaurants and bars (and they still get their CME hours). So, it is difficult for meeting planners, like me, to make everyone happy, or satisfy all requests for certain time zones or even to just let everyone pick and choose the topic, time, and lack of monitoring that they want. 


 


For now, I recommend picking the online meeting that you want, schedule the appropriate time out from the office or family, attend the virtual meeting, and try to learn something new. Hopefully, next year, it will be back to more normal and you can attend live meetings again. 


 


Dock Dockery, DPM, Seattle, WA

08/31/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Alan Sherman, DPM


 


There is no question that live conferences are going to be very hard to find for the rest of 2020 and, most likely, before next summer; and that most, if not all, CME will have to be done online. All podiatrists should lobby their state boards and associations to allow all their CME to be earned online sooner rather than later. We at PRESENT just ran an experimental scaled down “safe meeting” in NJ, this year’s Superbones Superwounds East 2020, and it was attended by 85 (down from 400 in 2019) and almost all attendees told us on the exit survey that they felt safe and would attend another such meeting if we ran one.


 


But we’ve decided to run all our fall meetings, the ResEdSummit, Superbones West and Desert Foot as live streaming events. Why? Because...


 


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

08/27/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Timing of Webinars


From: Jeffrey Kass, DPM


 


I have noticed since the pandemic hit that there have been an abundance of webinars offered to podiatry on various topics. I think this is great. I do, however, find it strange that a good majority of them are offered during normal office hour times. That seems odd to me. Wouldn’t it make more sense to offer them say somewhere between 6-9 pm EST, versus 12, 1, or 2 smack in the middle of the afternoon?


 


Jeffrey Kass, DPM, Forest Hills, NY

08/24/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Daniel Chaskin, DPM


 


The joint statement by Dr. Lombardi and Dr. Markinson is a positive first step. But, arbitrary discrimination is still present. To unify our profession, all discrimination must stop. There are 2 types of certifications. 1. Completing an approved CPME certified residency training program. 2. Becoming board certified. 


 


The joint statement did not mention about the failure to complete a certified residency training program. Some older podiatrists received informal training by the cases they assisted. Some taught podiatry residents who became residency directors. To demand a certified residency program be completed is both arbitrary and age discriminatory against older podiatrists who did not have the ability to obtain such training.  


 


Daniel Chaskin, DPM, Ridgewood, NY 

08/17/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: John Chisholm DPM


 


Why not now, indeed. No one is more qualified to evaluate podiatric medical education and training than the great Leonard Levy, and the finding of the California Podiatric Medical Association's Physician and Surgeon's Task Force mirrored those of Dr. Levy - our education and training are comparable to that of our MD and DO colleagues at the end of our 3-year residency programs. The final product is indistinguishable, except for our limited licensure vs. the plenary license given to MD/DOs. The problem isn't that we have the wrong degree. The problem is that our limited license doesn't accurately reflect what we do. 


 


CPMA believes there is another, better way to achieve true parity - to convert our present, limited license to an unlimited, plenary license. In other words, DPM=MD=DO. This is the simplest and easiest way to achieve our goal. It eliminates the need for a degree change. Our education and training is comparable to that of MD and DO physicians. We should be licensed as such. Why not now? 


 


John Chisholm DPM, Chula Vista, CA

08/13/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Transition from DPM to MD and/or DO? Why Not Now?


From: Leonard A. Levy, DPM, MPH


 


Much of the ongoing discussions about DPMs becoming DPM/MD or DPM/DO are understandably based on politics within the podiatric medical profession. Giving up the DPM in exchange for acquiring the MD or DO to this day is a result of arguments by members of our profession on either side of such a transition. Certainly such a transition would not be without volatility. However, using the cliche that a rose by any other name is still a rose, recognizes that we already are physicians based on what we do. 


 


Our day-to-day responsibilities are virtually a true analogy with other speciaties in medicine such as, but not limited to ophthalmologists, otolaryngologists, and other organ-specific specialties. True, while they were in medical school, essentially the only difference between such specialists and podiatric physicians today is that the MD or DO curriculum includes clinical and didactic education and training in obstetrics and gynecology, psychiatry, and pediatrics.


 


This typically amounts to less than six months of time. Most of this could be reduced by providing some of what now is part of the pre-doctoral training of a DPM into graduate medical education (i.e., residency) so that these omissions could be removed. I do believe that someday this will happen (because of us or in spite of us).  Why not now?


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL
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