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09/17/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Doug Richie, DPM


 


Dr. Udell suggests that orthotic labs should subsidize lectures at podiatry meetings and at the podiatry schools. This proposal underscores exactly why teaching the science of biomechanics has disappeared from all of the major educational symposia available to the podiatry profession. The content and speakers at these meetings have become heavily dependent upon corporate sponsorship and most of this comes from the wound care and surgical technologies industries.   


 


Foot orthotic labs with their meager profits and budgets cannot and should not be called upon to fund the teaching of an essential element of the podiatric curriculum. To assume that foot orthotic therapy represents the major delivery of skill and knowledge of biomechanics of the lower extremity is a sad conclusion. No student or resident should enter the operating room and be allowed to make an incision before mastering this subject. Biomechanics is an essential pillar of podiatric medicine AND surgery and should not rely on funding from commercial interests in order to maintain priority in our educational process.


 


Doug Richie, DPM, Long Beach, CA

Other messages in this thread:


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

11/20/2019    

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

11/07/2019    

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

11/06/2019    

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

11/01/2019    

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.

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

10/26/2019    

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

10/26/2019    

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



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

10/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Elliot Udell, DPM


 


I’m questioning why podiatry does not have specialties as dentistry does. This ignores a rather large elephant sitting in our living room. Dentistry has true specialties. There are periodontists, oral surgeons, endodontists, pediatric dentists, etc. The one difference between dentistry and podiatry is that dental specialists limit their practices to their specialties. 


 


If one goes to an endodontist for a root canal, or an oral surgeon for an extraction, those dental specialists would never be caught filling a cavity or making a crown for that patient. If he or she did, they could kiss their referral base goodbye. Podiatry is different. There are those who have greater training in surgery, biomechanics, pediatrics, or dermatology but I have yet to hear of any of my colleagues, outside of the academic arena, who limit their practices to any one area of specialization. Perhaps Dr. Levy could offer us some insight into why podiatry has not generated the types of limited specialty practices that we see in dentistry and medicine.


 


Elliot Udell, DPM, Hicksville, NY

10/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Doug Richie, DPM


 


I applaud Dr. Richie’s comments about the tragic devolution of our podiatry education away from the core discipline of biomechanics. The knowledge of biomechanics and foot function lies at the heart of our profession and must never be neglected.


 


Robert Frykberg, DPM

09/19/2019    

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



From: Jeffrey Root


 



Dr. Udell states he has no idea why orthotic labs stopped sponsoring biomechanics at conferences and podiatry schools. As the owner of a prescription foot orthotic laboratory I can shed some light on the subject. The short answer is that there is no/inadequate return on investment. Sponsorships are essentially a marketing expense for most businesses. If an orthotic lab can’t benefit from a sponsorship or if it can’t afford to fund one for altruistic purposes, then they are unlikely to do so.


 


The economics of the custom foot orthotic manufacturing industry have changed over the years. There was a time when the exhibit halls at podiatry conferences had many foot orthotic labs in attendance. That is no longer the case. In fact, exhibitors at podiatry conferences are down in general. It's extremely expensive to exhibit, sponsor speakers, or to otherwise financially support educational content. As Dr. Richie indicated, foot orthotic labs have relatively meager budgets and have watched their profit margins shrink for many years, in part, because podiatry has become more of a surgical specialty. Unless that trend changes, you are not likely to see orthotic labs support biomechanics like they once did.


 


Jeffrey Root, President, Root Laboratory, Inc.


09/19/2019    

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



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

09/18/2019    

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



From: Dale Feinberg, DPM


 


Dr. Borreggine’s excellent analysis of the future of podiatry hit the nail right on the head. He had been prognosticating that the demise of private practice was coming and now he has put out the word that private practice is dead. 


 


I started reading the tea leaves about seven years ago when the implementation of Obamacare started affecting my practice. Denial of payment for the medically necessary diabetic shoes was the opening shot in the war with...


 


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

09/18/2019    

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



From: Elliot Udell, DPM


 



Doug, in an ideal world, corporate entities would have no say in what is presented at medical conferences. We do not live in an ideal world. When I lecture at podiatry conferences, I don't always get paid and I have sometimes paid for my own room, board, and transportation, and given multiple lectures. Why do I do this? To be of service to my profession and the public it serves. There are others like me.


 


Unfortunately, this model is not sustainable even for me. Many conferences including ones that I have chaired cannot afford to subsidize all of its speakers or depend on all of its speakers to lecture for gratis. Hence, they have to turn to the corporate world for help or scrap the seminar. As for podiatry labs, when I started practice back in the 70's, Langer labs, Schuster labs, and other labs did sponsor biomechanics at conferences and at the schools. Why did they stop? I have no idea. 


 


Elliot Udell, DPM, Hicksville, NY 


09/18/2019    

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



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

09/14/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Welcome to the Future of Podiatry


From: Joseph Borreggine, DPM


 


Who needs a podiatrist when you can just buy a pair of custom orthotics on your own? Soon not one insurance will pay for orthotics, but what does it matter anyway? A new class of DPMs are now entering the profession with the mindset that they are only “foot and ankle” surgeons.


 


They opine that general podiatry is truly passe’and is beneath the DPM degree. All the time and money invested in their degree that was earned along with the required 3-year surgical residency is far beyond the... 


 


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

09/11/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Paul Busman, DPM, RN


 


I too had some human bones left over when I closed my practice, including an entire leg and half pelvis, and a nylon threaded disarticulated foot. I gave them to a local podiatry group where I was working part-time to use as I did in my office, for patient education. 


 


Paul Busman, DPM, RN, Frederick, MD

08/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: The Problem With the American Healthcare System


From: Jill Hagen, DPM


 


I received a refund request from Humana yesterday. I checked the patient’s account and saw I was overpaid, and in fact, the refund was legit. I then decided to call Humana insurance today to pay the refund.  After 20 minutes on the call, I finally got the representative whom I told I was calling to pay the refund. She asked me these questions: name of the patient, insurance ID number, claim number, and date of service. I answered all these questions. Then she asked, “What is the patient’s date of birth”? I did not have the answer in front of me.  


 


She then said, sorry, I cannot help you if you don’t know the patient’s DOB. I told her that I wanted to speak to her supervisor. She said the supervisor was not available and she was sorry but there was no more she could do for me. I then told her, “if you see your supervisor, tell her a doctor called to pay a refund due, and that you could not process this refund without the patient’s DOB. If this insurance rep worked for me, she would be fired on the spot! This can only happen in the American healthcare system.   


 


Jill Hagen, DPM, Englewood, NJ 

07/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Martin M Pressman, DPM


 


I agree with Dr. Allen Jacobs completely. The use of graded pulses (+1 thru +4), capillary filling time, and hair growth as the standard podiatric documentation, while necessary, is simply not enough. Hand-held Doppler evaluation is an inexpensive method of determining the quality of pulses: monophasic, biphasic, or triphasic. Documenting the presence and quality of the three foot pulses with a Doppler and referring to a vascular consult or ordering vascular ultrasound imaging/ABI for absent or monophasic sounds would save limbs and time spent in depositions for a missed diagnosis of PAD.


 


Martin M Pressman, DPM, Milford, CT

07/09/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Richard M. Maleski, DPM


 


Dr. Udell's post reminded me of an incident about 4 or 5 years ago at our community hospital. The wound care nurse at the hospital, who also worked part-time for a home nursing service, apparently took some training course for routine foot care and started advertising, with the hospital's blessing, her availability for nail care and corn/callus care. My understanding was that she could not bill any insurance, cash only. 


 


I became familiar with her since I worked closely with her on some wound cases, and therefore felt comfortable talking to her about her new "business". She told me that she stopped after a few patients because she didn't realize how difficult it was to adequately provide... 


 


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

07/08/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Daniel Chaskin, DPM


 


Consolidating podiatric medical boards with foot and ankle surgical boards would be a positive first step to prevent what I believe is discrimination by hospitals, against podiatrists who are board certified in podiatric medicine.


 


Unfortunately, some hospitals require board certification in surgery. If podiatrists lack these credentials, they can be excluded from a hospital's operating room. 


 


Daniel Chaskin, DPM, Ridgewood, NY

07/05/2019    

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



From: Andrew Levy, DPM 


 


I feel a need to add another voice of support to Doctor DeHeer's concerns and important consideration for finding ways to prevent suicide among our residents and our peers. We too have suffered the sadness of this tragedy in our community, in our professional ranks, and with our professional colleagues in other fields. I discussed this today with a patient who is director of a post-doc program in our community, and they also have that problem as well. This is, unfortunately, ubiquitous to all of our societies. 


 


While we search for the appropriate tools to study the phenomenon and assess different tools to help fight the problems through mentorship, referral to physician services, or the importance of enlightening our fellow colleagues, the important work must...


 


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

07/05/2019    

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



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


07/04/2019    

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



From: Jessica Tabatt, DPM


 



Thank you, Dr. Bellezza, for showing us that there is still an unfortunate stigma surrounding mental health that prevents people from seeking the care they need. If a person is stressed, you cannot tell them that they are not, nor should they not be stressed. This would be like telling me that I am not hungry because you are not hungry.  


 


I took my residency and now my current career seriously. Even though my patients are not dying, I still have their health and well-being under my care, which can be very stressful at times.


 


Jessica Tabatt, DPM, Brainerd, MN

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