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From: Patrick DeHeer, DPM 


Yesterday, as I stood in the hallway at a memorial service for a respected Indiana podiatric physician, Dr. Belleza's response to my post on PM News came to mind as I watched my colleague's wife cry throughout his memorial service and his son sing beautiful hymns. My colleague called me looking for help two days before he chose to take his own life. Our conversation ended on a positive note as I offered some ideas and suggestions to assist him in his time of need. We were not best friends, but we were professional colleagues for more than 25 years. This explains him reaching out to me. 


The Tuesday, after I learned of the incident, I emailed about 30 leaders within the podiatric profession to assist getting our survey out to podiatric residencies so we can, in fact, examine if suicidal ideation in podiatry is similar to that of our allopathic and osteopathic colleagues. Shortly after my initial email, I was informed of four other DPMs committing suicide (one third-year student, one resident, one attending at a residency program, and...


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

Other messages in this thread:



From: Alan Sherman, DPM


Dr. Allen Jacobs in a recent letter said, “I was evaluating a post-op Austin-Akin patient today. She told me that she watched the (My Feet Are Killing Me) reality show. Her exact words were; “I’m impressed. I had no idea podiatrists did such complicated things.” This just goes to show you how different a patient’s perspective can be from a physician’s. I’m wondering what she saw on the show that seemed more complicated than the intricate surgery that she had done by Dr. Jacobs. Maybe she meant, “unusual” or “serious” or “rare” or “bizarre”, but complicated? We should all be more aware of how different a patient’s perspective can be from our own.


By the way, keep an eye out for media segments that Drs. Ebonie Vincent and Brad Schaeffer did on the Dr. Oz Show, TMZ, DailyQ, Good Day, and recently, they filmed a segment for the Tamron Hall Show which aired on Friday at 1PM. These two podiatric reality superstars have been quite busy talking up podiatry to a huge national audience.


Alan Sherman, DPM, Boca Raton, FL



RE: My Feet Are Killing Me Cable Series

From: Keith L. Gurnick, DPM


To all of us who are watching or will watch the new show made for TV, "My Feet Are Killing Me" Cable Series, please understand that this is a made for TV show and is for the purpose of  entertainment to viewers. Don't expect to see on television that every patient is greeted, examined, diagnosed, and treated as if you were their doctor in your practice or office. Patients for these types of shows are cherry-picked for various reasons, and filming is edited down to produce a final product without  doctor involvement. 


Do not assume that what you see on TV is the full extent of the treatment. Do not expect many of the patients to exhibit the problems that most of us encounter. These might seem to the TV audience to be extreme and often include unusual back stories for the patient or their families  to make the show more interesting. 


Keith L. Gurnick, DPM, Los Angeles, CA



From: Brent D. Haverstock, DPM


It would seem that if podiatry is to become a branch of medicine (MD/DO), the APMA would have to meet with the American Medical Association (AMA) and the American Osteopathic Association (AOA) to see if there is a desire to see this happen. If there were an agreement, the schools of podiatric medicine would have to close. The APMA and AMA/AOA along with the Accreditation Council for Graduate Medical Education (ACGME) would establish appropriate training programs.


I suggest a 5-year commitment to become a podiatric surgeon and 3-years to become a podiatric physician. Podiatric medicine and surgery would have a single certification board with specialist certificates granted as either a podiatrist or podiatric surgeons. Medical students (MD/DO) could consider podiatry or podiatric surgery as their career path. This is the only way to...


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



From: Leonard A. Levy, DPM, MPH


Elliot Udell, DPM, asks a great question, namely, “Could you offer us some insight into why podiatry has not generated the types of limited specialty practices that we see in dentistry and medicine?” I served a total of 14 years as dean and then president of the then California College of Podiatric Medicine. For another 14 years, I was founding dean of the College of Podiatric Medicine and Surgery of the then University of Osteopathic Medicine and Health Sciences (Des Moines, Iowa). I just spent 17 years as associate dean of the Nova Southeastern University (NSU) College of Osteopathic Medicine learning in detail the intricacies of a DO curriculum. I just completed a year serving of the curriculum committee of NSU’s new allopathic medical school and currently serve as an interviewer of applicants to that school.


I was successful in modifying the pre-clinical aspect of podiatric medical education at the California and Des Moines podiatric medical schools and led the way in California to a podiatric medical residency that was 2 years in duration, virtually unheard of at that time. But the profession for years kept focusing on preparing DPMs who were qualified podiatric surgeons. While vital, it is time to expand that narrow perspective and provide graduate medical education that leads to the production of highly qualified podiatric physicians comprehensively training, experienced, and certified in the relatively neglected area of medicine related to the pedal extremity.


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



From: Alan Sherman, DPM


The always erudite Elliot Udell’s call to orthotic companies to support biomechanics education is currently being generously met by Scott and his son Robert Marshal of KLM, Michael Friedman of Redi-thotics, and Pavel Repisky of 8Sole, all of whom sponsor podiatric education. 


Doug Richie, DPM shared an important point: for podiatrists, there is so much more to biomechanics than orthotics. While all corporate entities working in the podiatry space should do their share, I would add that while we all appreciate corporate sponsorship, we can’t and shouldn’t ever rely on it to choose what is taught at the colleges or at the post-graduate level.


Alan Sherman, DPM, Boca Raton, FL



From: Ira Baum, DPM


I couldn’t agree more with Dr. Ritchie. Without mastering the fundamentals; one can never become a master. Techniques to cure a deformity develop from understanding the root causes. With the exception of congenital deformities, abnormal lower extremity mechanics play a primary factor. John Wooden, the immortal UCLA basketball coach and philosopher, once said “If you only try to learn the tricks of the trade, you will never learn the trade.” The trade of being an expert podiatrist/foot and ankle surgeon is understanding the cause of the pathology and applying the solution. 


Regarding foot/ankle surgery - without understanding the biomechanical fault causing the deformity, even the surgeon with the greatest hands will fail most of the time. I say most of the time because in golf lingo, "Even a blind squirrel finds an acorn once in a while." Learn what our masters in biomechanics have uncovered and you’re on your way to becoming an expert. Regarding who sponsors lectures at symposiums is an issue, but whatever the solution, lower extremity biomechanics should be an integral part of most conferences, and all surgical conferences.


Ira Baum, DPM, Naples, FL



From: Norman Rubin, DPM, David E Gurvis, DPM


My partner of thirty years tragically committed suicide just as we had sold our practice and were about to retire. He was financially secure and was looking forward to his retirement. In addition to being my partner, he was my best friend. You would have thought that if anyone should have seen the warning signs early on, I would have seen them.


About a month before he committed suicide, however, I noticed a significant change in his personality. I spoke with my partner about my observations, but he insisted that he was doing fine. Nevertheless, I was concerned and...


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


I was also at the memorial service for one of my oldest friends. I have known him for over 30 years. I am also a colleague of Dr. DeHeer and know he is prone to action, not simply talk. When he speaks of suicide prevention in doctors, he is speaking from a position of knowledge and caring. I personally know he cares about others. I don’t know Dr. Bellezza, but I find his comments very offensive and lacking any care or understanding of human psychology.  


Were we able to weed out those who might become depressed later, I would support giving them the ability to accept counseling or medication as necessary, just as I would anyone suffering. However, to prevent someone from entering podiatry school simply because they may have depression is untenable. To simply say we should weed them out, besides being impossible, shows no ability, in my opinion, to exhibit sympathy for those suffering from depression.


David E Gurvis, DPM, Avon, IN



From: Peter Bellezza, DPM


Dr. DeHeer, my original message was to point out that if you want to design a research tool to predict behavior/suicidal ideation in the podiatric residency training model, you have to consider the disparity of training between the individual podiatry residency programs, the training disparity between podiatry residency training vs other med/surgery specialties and the disparity in student preparedness for residency training when comparing the DPM vs. the MD/DO medical education system. If you think there is no disparity in any of the above, then that’s an entirely different debate.


Residents who work longer hours are going to have social factors that can come into play that could increase the potential suicidal ideation. That’s obvious. For residents that have succumbed to suicide, was it really because medicine (the work) drove them to it? Or are we dealing with individuals with extensive histories of anxiety, depression, substance abuse, etc. that entered the field of medicine? These are important questions to ask. 


Understanding the medical and social history of residents may be important screening tools to better identify residents who are at risk during residency training. I look forward to reading the data you produce. I apologize if I offended you and others with my initial response. 


Peter Bellezza, DPM, Bristol, CT



From: Elliot Udell, DPM


Doing a survey among podiatric residents and maybe even all podiatrists could reveal important and maybe even life-saving information. That being said, I suspect that the data will reveal that there is a much lower percentage of suicidal ideation among podiatric residents than among MD and DO residents. Why? Although podiatric residents work as hard as any other residents, we do not deal regularly with patients that might be dying of a disease.


When I was a student, I attended an inquest at a hospital rotation. A child died. Present at the autopsy were the pathologist, the pediatric resident, and I as an onlooker. When the pathologist was finished raking the pediatric resident over the coals using 20/20 hindsight, I was afraid that that resident would jump off the roof of the hospital.


With the exception of missing severe vascular disease or a melanoma, we don't deal regularly with life-threatening diseases which could cause us mental anguish. Nevertheless, the survey that Dr. Deheer is working on could tell a totally different story.


Elliot Udell, DPM, Hicksville, NY



From: Allen Jacobs, DPM


With reference to the issue of sterilization vs. disinfection of nail cutting instruments, there is a difference between the theoretical and practical. Do you disinfect your exam chairs between patients? How about counter-tops between patients? Your Doppler probes or blood pressure cuffs between patients? Do you wear sterile gloves while handling your autoclaved nail cutters? Do you discard all multi-dose vials 28 days after initial use? Do you terminally clean exam rooms in which you perform invasive procedures?


I was trusted by the Missouri Podiatric Medical Society to prepare and present sterilization and disinfection protocols to the state society members, as such training is required every 2 years in Missouri. In fulfilling that obligation, I conducted...


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



From: Spencer F. Dubov, DPM    


In response and support of Michael Schneider’s recommendation apparently to retirees to retain their licenses as long as possible, I am in total agreement since no one knows what the future may bring. But one of the nicest features of New York licensure is you never lose it and simply by paying the current fees and taking the required CME credits, the license is completely restored. I wonder what other states offer this “way back”.


Spencer F. Dubov, DPM, (Retired) Naples, FL



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



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



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



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



RE: CMS' Discrimination Against Podiatrists

From: Lawrence M. Rubin, DPM


The decision of the CMS policy-making gurus to try to save some federal dollars by cutting payment for E & M medical care provided by podiatrists is, to say the least, ill-founded and discriminatory. I believe in healthcare cost-containment measures, but only if they conform to existing rules and regulations. This proposed rule does not do this. For it to conform, Medicare would have to first change its definition of the word "physicians." 


APMA is expertly representing us in its efforts to maintain parity with the other professionals designated by Medicare as physicians – MDs, DOs, optometrists, and chiropractors. With this in mind, I believe what CMS is attempting to do with podiatry should be a “Heads Up!” to optometrists and chiropractors. If CMS gets its way with podiatry, I bet optometrists and chiropractors will be next on its attack list. I hope APMA is keeping this in mind and discussing this issue with the optometric and chiropractic national professional organizations. Together, we could be stronger. We could be a united force in trying to convince Medicare to maintain present Medicare parity regulations.  


Lawrence M. Rubin, DPM, Las Vegas, NV



From: Jeffrey Kass, DPM


I agree with Dr. Siegal's comments regarding seeking equal pay for equal work. I also feel this should not be limited to Medicare and their particular payment system. It is ludicrous that all other payers do not have a standard payment system. Different providers within the same specialties are paid at different rates. This is something the medical community at large should have stopped dead in its tracks when it first started.


Jeffrey Kass, DPM, Forest Hills, NY



From: Len La Russa, DPM


We, as podiatrists, are all worried about the dwindling number of pre-med applicants applying to podiatry school. Could part of the problem have anything at all to do with the 50% passing rate for ABPS certification? Orthopods don't have that problem. Or is it possibly the chance that there might not be a position available for residency? The low passing rate is much easier to fix than the residency crisis, which is less of a crisis now. Another impediment to getting talent to apply to podiatry school could easily be addressed by increasing the pass rate so that it is no longer such an embarrassment. 


Len La Russa, DPM, Americus, GA



From: Brian Kiel, DPM


I, just like many podiatrists, see patients who have been treated by Costco and urgent care facilities. I, like Dr. Jacobs, will not deal with devices that others have made. I explain that it is a useless device and I cannot and will not take responsibility for them. On the other hand, if someone comes into my office with a boot and a fracture, or an improperly treated condition of the foot, I don't feel that we can or should refuse them. If another facility screwed it up in the first place, then they probably won't get it any better the second. It is our responsibility to do everything we can to help that patient. Of course, proper charting regarding the prior care is critical, but we have an ethical responsibility to care for those patients.


Brian Kiel, DPM, Memphis, TN



From: Janet McCormick, MS


The EPA-approved label on Benz-All says weekly. It does not say, however, if Benz-All is rendered ineffective by bioburden, meaning it might or probably needs to be changed earlier. The EPA requires that hospital disinfectants kill certain benchmark microbes and Benz-All does that. Many disinfectants, however, are tested for further levels of kill, and these are added to the label as "label dressing" since no disinfectant at this level kills everything. In other words, it's designed to improve sales. Keep in mind that there are many organisms it does not kill, but that is true of every disinfectant, no matter the brand. Only sterilization kills them all = use of an autoclave.


There are those that say disinfection is the okay-level of care for podiatry instruments unless you are performing invasive treatments. But any treatment can cause any level of invasion by instruments (in any type of care - podiatry or otherwise), even by accident, so any procedure must be performed under aseptic conditions Doesn't that call for sterilization of instruments in podiatry? Even in the offices? I am always shocked when I go into a podiatry office and there is no autoclave! But it happens way too often! In a survey of podiatry offices in my area, 4 out of 6 offices did not have an autoclave. 


Janet McCormick, MS, Frostproof, FL



From: Mike Kempski


I work on the insurance side of medical malpractice and have twenty five years of experience. In the early years of the Data Bank, the doctors had great concerns about entries against them. The concern was so intense that the carriers responded by changing their policy language as it relates to the settlement of claims. The change was the policies stated they won’t settle a claim without your consent to do so. However, I don’t think there was much reason to be worried. There’s very limited access to the Data Bank. For example, the general public (your patients) can’t access it. Medical malpractice insurance carriers can’t. Hospitals can. But they’re always very reluctant to revoke privileges. How has it hurt physicians?


Mike Kempski, Plymouth Meeting, PA



From: Don Steinfeld, DPM


Kudos to Brian Markinson. We should all remember that every interaction we have is an opportunity to promote podiatry as a profession and ourselves. What a positive outlook he has. It’s so easy to fall in step with negative thinking and negative thoughts. This is a great way for all of us to start the new year on a positive note. 


Don Steinfeld, DPM, Farmingdale, NJ



RE: ABFAS Board Exam Pass Rate is Disparaging (Joseph Borreggine, DPM)

From: Don Peacock, DPM


The complaints regarding the ABFAS board certification process are completely unwarranted. I say this not to be elitist but to recognize that we all should strive to remain independent. I feel empathy for anyone going through the board certification process. I remember it well and it was challenging. However, I do not feel sorry for anyone complaining about it. The experience should be difficult and will make you more knowledgeable in the end. Complaining about it is silly and serves no purpose. You should prepare and do your best; and like a boxer, you need to be strong enough to give and take a punch. 


I will be taking the recertification exam in 2018 and I plan to study and pass it. If I do not...


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



From: Adam Siegel, DPM


Dr. Williams mentions that we must “not be inferior to that of our MD colleagues.” So I suppose the solution is to do what most podiatrists seem to do: overcompensate in an effort to unnecessarily prove something to an audience that does not exist. If orthopods see a suitable pass rate as 90%, podiatrists should aim to set our pass rate at a comparable level. After all, it is completely up to the board to determine what arbitrary score is considered “proficient.”


Adam Siegel, DPM, Lutz, FL



From: Harry Penny, DPM


CMET has the only physician-specific organization certifying all prescribing MDs, DOs, and DPMs. CMET is different from the other certifying bodies in that they do not certify physical therapists, CNPs, or nurses in wound care. CMET certification is well accepted and respected, and an important certification for hospital and wound center privileges. If you want, you can go to the website for the Academy of Physicians in Wound Healing and sign up for their review course before sitting for the exam. 


Harry Penny, DPM, Altoona, PA

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