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09/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM


 


Thank you, Dr. Levy for shining a light on such an interesting topic. We should all weigh in on this!


 


Podiatrists very often see patients more frequently than their primary care medical doctors. We also take care of patients who do not have primary care general physicians. In both cases, should we be asking more questions on a regular basis regarding certain aspects of their general medical history. We ask patients about diabetes because it relates to foot pathology. Should we be asking patients if they have been vaccinated for measles and other illnesses?


 


What about asking patients past the age of 50 if they have had a colonoscopy? What about asking all post-menopausal women if they have had their first bone density scan? There is more we can ask and in so doing we can make an even greater contribution in the public health arena. By referring these patients to appropriate specialists, we would also increase our professional relationship with a host of other medical professionals. 


 


Elliot Udell, DPM, Hicksville, NY

Other messages in this thread:


11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Elliot Udell, DPM


 


Dr. Jacobs cites seven problems with the teaching of biomechanics to the profession in 2019. His seventh critique was that many CME seminars are filled with "pay to play' biomechanical presentations which are "edgy and unproven." This made me chuckle because I have sat in on biomechanical lectures where a speaker espoused theories to justify his or her line of orthotics and two hours later a different speaker representing a different company says something that is the exact opposite. Too often, true experts are not invited to the podium.


 


This problem leads into Jacob's third critique (The overwhelming number of journal publications in the area of biomechanics are by professionals other than podiatrists). Criticism without solutions is blowing into the wind. The only solution is for the APMA, the schools, the labs, and private donors to make the sacrifices, fund the research, do it at an affordable price at our colleges, and publish good papers in our journals. That way we can take biomechanics out of the realm of private opinion and into the realm of evidence-based medicine.


 


Elliot Udell, DPM, Hicksville, NY

11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: OH Podiatrist Shines at House Intelligence Committee Hearings


From: Burton J. Katzen, DPM, Bret M. Ribotsky, DPM


 


Hats off to Congressman Dr. Brad Wenstrup for being such an eloquent representative of our country and our profession.


 


Burton J. Katzen, DPM, Temple Hills, MD


 


While I know very few PM News readers have the opportunity to be watching the hearings of the House Intelligence Committee on TV this week (and last week), I just want to report something no news media is reporting. Our own representative, podiatrist Brad Wenstrup, DPM, is clearly making all of us very proud. His name plate says “Dr.” and his questions have all been very thought-out, probing, and a clear demonstration that he is well learned on the subject. All DPMs should be proud of the voice we all have in Congress, and we can only hope that Brad wishes to continue to stay in Congress, as it’s clear he has the respect from both-sides. Once again, we should all be proud of our 2018 PM Podiatry Hall of Fame inductee.


 


Bret M. Ribotsky, DPM, Boca Raton, FL

11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM


 


We are using Transworld Systems. Easy to use.


 


Robert Scott Steinberg, DPM, Schaumburg, IL

11/20/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Allen Jacobs, DPM


 


The question of biomechanics/kinesiology education in podiatry is an important one.


Some observations:


1. Residents with whom I speak tell me that it is distinctly uncommon to see gait analysis performed on most patients, including those being evaluated for surgical intervention;


2. As an ABFAS reviewer, I can tell you that a detailed documented weight-bearing examination is typically not present;


3. The overwhelming number of journal publications in the area of biomechanics are by professionals other than podiatrists;


4. Most biomechanics education at CME programs is corporate supported, and lectures are biased toward the products distributed by the corporation providing the grant or speaker;


5. There is too much reliance on radiographs in surgical decision-making when such data cannot be interpreted in a vacuum;


6. Gait analysis must include requisite knowledge of interrelated factors such as neurology and pathology above the foot and ankle;


7. Too many unproven and edgy theories, always product driven, are allowed to be presented at CME meetings; it is another example of so called scientific directors of programs allowing the “pay and you can play” construction of CME programs. Students and residents know what they see. What they do not see is the incorporation of serious biomechanics/kinesiology evaluation in patient care. Until they do, a minimal appreciation and application of these sciences will continue to be relegated to the status of a rite of podiatry passage no more considered in daily practice than the Krebs cycle.


 


Allen Jacobs, DPM, St. Louis, MO

11/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: The Richard O. Schuster Memorial Seminar


From: Chuck Ross, DPM


 


I recently attended the Richard O. Schuster Memorial Seminar and had two immediate thoughts. First, I was incredibly impressed with the presentations and the manner in which Dr. D'Amico and his dedicated staff managed the entire weekend. Congratulations on a superb job.


 


My second thought brought me back to the recent discussions on PM News about the "lack" of appropriate education in the area of biomechanics with some blaming the shortcomings on the colleges of podiatric medicine. After the many superb and timely presentations, I must beg to differ and perhaps place blame...


 


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

11/11/2019    

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



From: Allen Jacobs, DPM


 



CBD topical preparations appear to be very helpful for symptomatic treatment of musculoskeletal disorders (e.g. arthritis, tendinitis ). I offer this has an alternative to those patients in whom oral NSAID therapy is not appropriate or concerning, e.g.: renal concerns, cardiac concerns, anticoagulation therapy, history of GI pathology). Typically, high NSAID risk patients are given the choice of topical NSAIDs, CBD topical, or no treatment. I personally use the CBD products from EBM pharmacy. The results have been excellent. I prescribe CBD topical daily.


 


Disclosure: I have lectured for EBM pharmacy in the past.


 


Allen Jacobs, DPM,  St. Louis, MO


11/11/2019    

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



From: Steven Finer, DPM


 


I recently purchased Quantum Rub at a seminar. It contains polarized CBD, menthol, and various herbs and oils including vitamin E. My wife has used it after our trips to the gym. She said that it helps with generalized soreness, not strong pain. Naturally, this is anecdotal evidence. It seems all rubs contain menthol for their cooling effect. Many can contain ingredients that produce warmth and new evidence shows it may speed healing. As to the claim of polarization, it is unproven. Ingested CBDs in the form of pills and gummies may be taken off the market due to lack of standards. I personally prefer Voltaren gel on a limited basis, as there is some systemic absorption.   


 


Steven Finer, DPM, Philadelphia, PA

11/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Shortage of PMSR/RRA Programs (Daniel Chaskin, DPM)


From: Charles M Lombardi, DPM, Alan A. MacGill, DPM


 


First, Dr. Chaskin is in error on several fronts. Most programs are PMSR/RRA. Second, it is only select states (that used the unified residency training model) in which one cannot do leg soft tissue procedures. 


 


Charles M Lombardi, DPM, Flushing, NY


 


According to the 2020 CASPR Directory, nearly all of the podiatric residency programs in the country are PMSR/RRA with the exception of only 9 programs.


 


Alan A. MacGill, DPM, Boynton Beach, FL

11/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From Paul Kesselman, DPM


 


I have also been attempting to secure new blood on several committees which I participate in both at the state and national level. While I understand the newbees have other priorities (raising kids, etc.), the future of this profession cannot be dictated (nor should we want it to be dictated) by generations who came before you. We have come a long way since I came back from Chicago in 1981 but there are many more roadblocks ahead, for which we need a younger person's stamina and perspective. Please consider Dale's invitation to participate in whatever way you can. The future of this profession needs your contributions!


 


Paul Kesselman, DPM, Woodside, NY

11/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Alan Sherman, DPM


 


In Charles Lombardi’s comments on the discussion regarding the need for a separate medically intensive podiatric medical residency, he criticizes certain unnamed people for being schizophrenic, for changing their minds as to whether such a program is needed between 2000 and 2019. To be clear, I am not for such a program. But I would point out that we are all scientists, trained to collect data and draw the best possible conclusions from that data, and that data has changed as podiatric practice and training has evolved in the past 19 years.


 


The situation is now quite different than it was in 2000. That “certain people” have changed their opinions during those 19 years is not only reasonable, but it is admirable. In fact, those who cling to obsolete opinions in the face of new and changed data are not...


 


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

11/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Time for The New Generation of Podiatrists to Speak Up


From: Dale Feinberg, DPM


 


I’ve followed PM News for quite some time and noticed that there are only a limited number of practicing podiatrists who are either proactive or reactive to the many subjects brought up on the open forums. If you read their current posts, it appears that many are about to hang up their white coats. I can’t believe that out of over 18,000 daily subscribers, the new generation is not stepping up to let us know what they think. 


 


When I was editor of the First Amendment at the California College of Podiatric Medicine, I was tasked with editing, writing, layout, and publishing 95% of each issue. I guess things haven’t changed much in the last 40 years. Please step up and help Barry keep this blog going. He needs new blood and he needs our help. To post a comment or respond to one, simply reply to PM News or send an email to bblock@podiatrym.com.


 


Dale Feinberg, DPM, Yuma, AZ

11/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Shortage of PMSR/RRA Programs


From: Daniel Chaskin, DPM


 


Currently, there are two residency models. Model number one is a PMSR. Upon completion of this model,  podiatrists are unable to become licensed to treat the ankle (with the exception of contiguous foot wounds) throughout every state in our country. Model number two is a  PMSR/RRA which does allow a path for a podiatrist to possibly qualify to medically and surgically treat the ankle. 


 


The problem is that there is a shortage of PMSR/RRA programs. Some podiatrists only are able to participate in a PMSR. A PMSR/RRA is required to ultimately allow podiatrists to medically treat the ankle in all states throughout our country. Medically treating the ankle regarding conditions such as melanoma, etc. is so important. Podiatric medicine includes the excision of melanomas on the ankle. Even if PMSR podiatrists actually completed a PMSR and became board certified in podiatric medicine, they still could not medically treat the ankle regarding conditions such as excision of melanoma. This may be one reason to replace all PMSRs with PMSR/RRAs.


 


Daniel Chaskin, DPM, Ridgewood, NY

11/05/2019    

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



From: Leonard A, Levy, DPM, MPH


 


Brent D. Haverstock, DPM said, "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)..." This remark and so many others from podiatric physicians seem to indicate that the "appetite" for DPMs to acquire an MD or DO degree is rapidly increasing. However, before any meetings take place with the AMA or AOA and the APMA, it is essential that strategic planning take place to determine exactly what the profession needs to do and what needs to be done to get there. 


 


Such an activity must, at the least, include representation from the APMA, the Association of Colleges of Podiatric Medicine, representatives of the current licensing examination body (i.e., American Podiatric Medical Licensing Examination), and the bodies within our profession that represent both the accreditation of undergraduate podiatric medical education and graduate podiatric medical education (i.e., residency training). 


 


It would be a disaster if such a plan was not properly developed and members of our profession were not on the same page. Our effort needs to be one having a uniform voice devoid of bickering by individuals and groups in the profession. The strategic plan developed should be articulated in a document containing the background of the proposal, the state of the profession, including its current education and training, and a detailed description of what is being proposed. I suggest that the time is ripe to undergo such an effort but that it needs to be done very carefully. This formal process must begin now.


 


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

11/05/2019    

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



From: Robert Scott Steinberg, DPM


 


Yes, the train has left the station, and I hope for good. Those who think differently just don't get it. Just as we get our schools to move to a complete set of courses, matching those of medical students, the last thing we need is to divide us into tiny pieces, each of which will be ignored and lost on other physicians and patients.


 


More than anything else, doctors of podiatric medicine need to become a stable, cohesive profession, and anyone attempting to divide us should be shown the door.


 


Robert Scott Steinberg, DPM, Schaumburg, IL

11/04/2019    

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



From: Alan Sherman, DPM


 



I’m confused by Leonard Levy’s most recent message in this discussion in the October 31, 2019 #6,539 issue, in which he refers to the “highly controversial proposal to have two specialty boards in the podiatric medical profession (i.e., podiatric surgery and podiatric medicine”. It’s not a proposal. We currently have these two specialty boards, ABPS and ABFAS. What we don’t have is two medical specialties. We have two specialty boards that represent one specialty, podiatry, and that structure is what is confusing the public and the medical establishment.


 


The proposal made by Jeff Robbins, DPM, supported by myself, Joe Borreggine, and now Brent Haverstock, DPM, is that our two specialty boards MERGE and form one board with sub-specialties, including advanced foot and ankle surgery and...


 


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


11/04/2019    

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



From: Charles M Lombardi, DPM


 


All this musing about two separate training programs is amusing to someone who has been around for some time and has been intimately involved in the progression of this profession. In 2000 or 2001, the CPME ad hoc committee to rewrite the 320 document recommended to the HOD and the community of interest three separate programs: A 2-year surgical, a 3-year surgical, and a 2-year primary podiatric care program. The APMA HOD and the community of interest REJECTED it outright, stating that ALL podiatrist must be trained the same. Some of the SAME people that were opposed to a separate primary podiatric care program are now in favor of it. The ABPS argued against a unified program, but lost the battle.


 


Now looking back, the unified program allowed many states to change the scope of practice laws because one of the arguments against us was a lack of unified training. Much good came from that decision. I was always in favor of two separate training tracks, but that train has left the station. To hear the SAME people who were opposed to a separate training program in 2001, but now say our profession must have two separate training programs are in psychiatric terms schizophrenic. Our profession would be considered a schizophrenic profession by lawmakers.


 


Charles M Lombardi, DPM, Flushing, NY

11/01/2019    

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



From: Robert Kornfeld, DPM


 



This discussion is a critically important one, especially because my professional path brought me to a deep understanding of human physiology, the foundations for health and healing, and a never-ending focus on understanding mechanisms of pathology BEFORE symptoms are treated. I pursued a path in functional medicine for foot and ankle pathology because it provides a means to heal pedal pathology AND improve the health of the patient. This has been my path and my passion since 1987 (I am a 1980 graduate of NYCPM). My career has been extraordinarily satisfying because the healing is in medicine, not surgery. Of course there’s a place for surgery, but without a true mechanistic approach to healing, we correct one issue but leave our patients open to future pathology.


 


Podiatry has always struggled with itself. In our zeal to be accepted as ”real doctors”, we focused on pushing ourselves into hospital operating rooms. Unfortunately, that...


 


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


11/01/2019    

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



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.

11/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: (David Laurino, DPM)


 


I partnered with a veteran in the VA (virtual assistants) world and created Bottleneck Medical. It has been a game changer and helped me get back about 10-12 hours/week, increased revenues, decreased my stress and burnout, and made it more enjoyable to see patients versus being a glorified secretary or court reporter. Ultimately, isn't that what it's all about? 


 


It's a vicious cycle. We’re trying to be patient-centric in a data driven world. It's an uphill, stressful, painful, and never-ending battle. My massive burnout hit about 3 years ago and I knew there had to be a better way. I went on a search for answers and discovered that virtual assistants were the answer to my biggest issues creating my burnout: lack of time, energy, money, and overall quality of life.


 


Disclosure: Dr. Laurino is co-founder and managing partner of Bottleneck Medical Virtual Services


 


David Laurino, DPM, Chandler, AZ

10/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Leonard A. Levy, DPM, MPH


 


In the ongoing discussions about the highly controversial proposal to have two specialty boards in the podiatric medical profession (i.e., podiatric surgery and podiatric medicine), Ira Baum, DPM remarks, “Unfortunately, it is the grassroots podiatrists who will suffer for their inaction. I strongly recommend those in leadership positions to consider these points and begin to explore options and opportunities for change”. 


 


James J DiResta, DPM, MPH further states that, “Many graduating podiatric medical students would benefit from an Intensive Podiatric Medicine Residency option. Providing this option for our graduates who do not want to be surgeons can have real value IF done correctly. That would work if we were able to engage Dr. Levy in this process in creating such a program.” 


 


I suggest that the best way to address these and related matters is to engage in major strategic planning and include leaders in the profession to once and for all determine the direction of this growing, exciting profession. As said in Alice and Wonderland, “If you don’t know where you are going, how will you know when you get there?” Certainly if it was thought I could help, as Dr. DiResta hints, I would be glad to do so at any level.


 


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

10/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Brian Kiel, DPM


 


I have used Entrada as my virtual scribe service and it is wonderful. I have no charts to take home nor any on weekends. When I leave the office, my charts are done. 


 


Brian Kiel, DPM, Memphis, TN

10/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Pennies Add Up (George Jacobson, DPM)


From: Steven Finer, DPM


 


This scenario happened to me. I couldn’t believe that we were getting these checks and had to process through the credit card company. I actually threw some away.


 













Check for $.01



 


However, I kept this .01 cent check and proudly display it.    


 


Steven Finer, DPM, Philadelphia, PA

10/28/2019    

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



From: James J DiResta, DPM, MPH


 



Many graduating podiatric medical students would benefit from an Intensive Podiatric Medicine Residency option. Providing this option for our graduates who do not want to be surgeons can have real value IF done correctly. That would work if we were able to engage Dr. Levy in this process in creating such a program, i.e. a 3-year residency curriculum in "podiatric medicine" that could provide for training in areas of general medicine, obstetrics, psychiatry, and make up for those clinical deficiencies our graduates presently have, provide for an allopathic or osteopathic medical school to sponsor the program so the resident can be provided a DO or MD degree, and get the residency in "podiatric medicine" ACGME recognized with accreditation.


 


I know those are considerable barriers to cross. As a profession, we may need to financially support such an effort in the initial roll out. We would need our students to take and pass the USMLE step 1 which we have known for some time is essential no matter what we do going forward. The completion of this type of residency would provide equal footing with our medical and surgical colleagues for OUR profession "podiatric medicine". Dr. Levy has provided alternative pathways for DPMs to the DO degree before. Perhaps this time, we can obtain a successful solution in a time span equal to that of our podiatric surgically approved programs and that would provide the value many of our graduates want who do not expect to be reconstructive foot and ankle surgeons. 


 


James J DiResta, DPM, MPH, Newburyport, MA 


10/28/2019    

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



From: Ira Baum, DPM 


 


Dr. Levy speaks from experience and knowledge, but the practical response from Dr. Purdy would be more effective and efficient. Taking into consideration the healthcare environment today with respect to student debt, years in training, and reimbursement schedules for podiatrists, it doesn’t make a lot of sense to pursue a regional specialty that other medical professionals serve based on a system specialty. There was a time for that type of specialty, but that time has passed. The train has left the station.


 


The obvious obstacle to transitioning DPM to MD/DO is the solid structure of the podiatric medical systems. Until those systems realize the future of the profession and see the value for those in leadership positions of our associations, educational institutions and boards to change, podiatrists' recognition will remain unchanged, and our war for parity will be never ending. Unfortunately, it is the grassroots podiatrists who will suffer for their inaction. I strongly recommend those in leadership positions to consider these points and begin to explore options and opportunities for change.


 


Ira Baum, DPM, Miami, FL

10/26/2019    

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



From: Jon Purdy, DPM


 


There is no need to compare dentistry to podiatry in this debate. Dentists are not defined as physicians nor do they have any competition among the medical community. Our closest colleague and competitor, orthopedics, has gone through its own transitions over the years. Originally a specialty in addressing pediatric deformities (the Greek derivation meaning “straight babies”) has transitioned to anything bone related in all age groups.


 


I find it a difficult argument to claim three years of residency isn’t a sufficient amount of time to learn the surgical and medical conditions related to the lower extremity. Orthopedics learns the surgical and medically related treatments of the entire body in four years. The first of five years concentrates on general surgery and medicine. Once an orthopedist’s standardized residency is completed, they may choose to do additional training in specialized areas or concentrate their practice on specific areas of their basic training.


 


Change is inevitable and our profession has not kept up. It should be obvious at this point, an MD degree will be our only acceptance into the medical world, fair or not. Aside from that, not having standardized training in ALL aspects of lower extremity care, and one single certifying board, is foolish, to say the least.


 


Jon Purdy, DPM, New Iberia, LA
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