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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:


03/13/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Eddie Davis, DPM,


 


Few healthcare professions have not attempted to increase scope of practice throughout the years. We need to take the focus off other professions that are striving to increase autonomy and scope and look at our own profession. If one considers our current scope of practice and then consider our level of training, we probably have the most training relative to scope of any health profession. 


 


We are foot and ankle specialists but have more training in general medicine, pharmacology, rheumatology, dermatology, infectious disease, neurology, and orthopedics than mid-level practitioners who are treating the entire body in those areas. The mid-level practitioners traditionally treat the entire body under MD/DO supervision but such supervision is minimal in many venues. That trend has been driven by managed care and government cost-saving initiatives.


 


A bill was introduced into the Washington State legislature years ago to allow DPMs to practice as physicians assistants for areas outside the foot and ankle but was opposed by that state's podiatry association. I think that such an expansion makes sense. Of course, it would be great to adopt an MD or a shortened pathway to an MD but that is a process that requires development. The PA option not only is easier to achieve, based on our training, but politically feasible due to the high demand for mid-level practitioners.


 


Eddie Davis, DPM, San Antonio, TX

03/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: George Jacobson, DPM


 


By simplifying the documentation, fraud and abuse is more easily identified. A family member’s in-law was a former army intelligence officer and spent 35 years as an insurance investigator for a large private insurer. Years ago, he told me his simplest slam dunk cases. They consisted of medical doctors who over-utilized high level visits and there couldn't have been enough time in the day to have seen that volume of patients billed for at that level of service. They requested money back and sometimes claimed intentional fraud in the big cases.  


 


This will be even easier to uncover with electronic appointment books and records. How could one bill all CPT 99204, 99205, 99214, and 99215 where the schedule shows patients were seen every 10 minutes? You'll have to be cognizant that the appointments scheduled match the time allotted for the visit, especially if you are in a high volume practice.


 


George Jacobson, DPM, Hollywood, FL 

03/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: We Are Showing We Have a Cure for the Coronavirus


From: Robert D Teitelbaum, DPM


 


I do not know why no one has spoken of the great hope that we can have that this Covid-19 virus is not going to be the modern day version of the Bubonic plague. Eighty percent of the cases are mild. They are mild because those patients have developed antibodies to the virus that are effective in dealing with the virion.


 


We are worried that it will take one or two years for an effective vaccine to be available when we already have a virostatic or virocidal cure that most patients are walking around with. It might be very effective to find and analyze these antibodies to see how they are effective. Also, children (not infants) do very well against the virus, some say because they have yet to abuse their lungs with various smoke sources, and their immune systems are robust. Also, one can't help but feel for those people who rely on Humira or Enbrel, when now susceptibility to infection takes on a more sinister tone.


 


Robert D Teitelbaum, DPM, Naples, FL

03/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: David E Gurvis, DPM


 


All the other specialties have an unlimited license to practice. They can work on the feet as they choose without specialized training. Recently, I treated  a terrified 19 year old who had a toenail partially removed in the ER a month ago. Why was he terrified? Because the ER doc ran a needle up under his nail to anesthetize the area. As it was infected, guess what didn’t work. I did a normal and typical toe block. Sure it still hurts but…guess who is coming back next time to me vs. the ER?


 


They, the unlimited specialties, are legally allowed to do anything. They can drill and fill teeth if they want to. It’s legal. They know they are no good at it, so they don’t. Feet? Well, not so much respect and the “I can do that” attitude prevails. We get the patients in the end regardless of who (mis)treats them first. After doing well once they are in our office and educating them….that’s the way to fight this. 


 


David E Gurvis, DPM, Avon, IN

03/04/2020    

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



From: Elliot Udell, DPM


 



Not every nurse practitioner is trained in treating from the ankle down. The same applies to MDs and DOs. When managed care first began, insurance companies put tremendous pressure on primary care doctors not to send patients to specialists, or risk being docked in some way. A patient finally was referred to me by a very good internist in my area. He had been treating her for over six months for tinea pedis to no avail. He finally used his better judgment and sent the patient for a podiatry consult. I had to diplomatically explain to the patient that the reason why her internist's treatment did not cure her foot problem was that even the best of antifungals do not have any effect on interdigital hyperkeratoses.


 


Elliot Udell, DPM, Hicksville, NY


03/04/2020    

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



From: Steve E. Abraham, DPM


 


My wife was a nurse practitioner. She worked in the orthopedic department at the hospital and was trained in orthopedic surgery. She learned about orthopedics and podiatry and had a really good knowledge base in both. After a while, her knowledge of orthopedic problems above the ankle was greater than mine. This included joint injections, knee and hip replacements, shoulder procedures, fracture care, and trauma. Our difference was the exposure we got. The things I did I got very good at and had much greater expertise than she did. Yet, she was exposed to so much more after she graduated and started to work.


 


It is not a question of who knows more, or who is better, the reality is we are all a team and each specialty provides appropriate care based on education, knowledge, and integrity. As a podiatrist, I give really incredible, high-level care to my patients, I treat the problems they come to me for. So did my wife, as a nurse practitioner, in the job she had. There is no competition because we did not compete with each other. We can all learn from and teach our colleagues and become better.


 


Steve E. Abraham, DPM, NY, NY

03/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Coronavirus in 2020 (Elliot Udell, DPM)


From: Daniel Chaskin, DPM


 


The coronavirus could be deadly for those patients with a weak immune system. This is why a podiatric exam might shed light on the above questions. Capillaroscopy using a dermatoscopy may lead a podiatrist to suspect a possible autoimmune disease. Blanched toes may indicate blood disorders such as anemia which may be a podiatric manifestation of a weak immune system.


 


Daniel Chaskin, DPM, Ridgewood, NY 

02/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Hartley Miltchin, DPM


 


They have discontinued the foot moisturizing cream because of poor sales in the foot category.  The CeraVe SA cream used on other parts of the body is the exact same formula.


 


Hartley Miltchin, DPM, Toronto, Canada

02/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: ABPM Non-Recognition of Residencies (William E. Chagares, DPM)


From: Daniel Chaskin, DPM


 


GME funding is linked to the fewest years needed for the certification process. Why can't such funding co-exist with an additional alternate path of 30 years' or 20 years’ experience in practice? The public is hurt by excluding qualified podiatrists from board certification with the experience and the knowledge to pass a certification exam. This would be a win-win situation for all experienced podiatrists who never got a residency match.


 


Daniel Chaskin, DPM, Ridgewood, NY

02/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Supna Reilly, DPM


 


The enPuls unit is extremely effective and has been a wonderful source of revenue for our office. We do 6 treatment sessions spaced 2-3 days apart, and charge $100/session. Literature suggests the efficacy of shockwave to be around 80%, and we have found that to be the case in clinical practice as well. It tends to be an easy sell for patients who don't want to go the surgical route or have plateaued in their progress. The customer service on the unit is also unparalleled. I recommend this unit.


 


Supna Reilly, DPM, Chicago, IL

02/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Kevin A. Kirby, DPM


 


The “Pose Method” and “Chi Running” are styles of running popularized over the past decade where coaches teach runners to try to land more on their forefoot, and not on their heels, during running. These two running “methods” were created by individuals who have sold books, produced videos, and have trained coaches to teach runners on “the proper way to run”. Neither of these running methods, which have likely made their creators lots of money, have been shown to be more “natural”, more metabolically efficient, or less injury-producing than other running styles.


 


Pose and Chi running became popular during the barefoot running fad of 2009 to 2015, where many self-proclaimed “running form experts” on the Internet asserted, without supporting scientific research evidence, that...


 


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

02/03/2020    

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



From: Stephen Kominsky, DPM


 



The last few words spoken by [Dr. Jacobs'] patient have been my mantra for the 37 years that I have been in practice. Instead of the APMA producing Johnny Sorefoot Balloons and the like, I have always felt, and feel even stronger today, that it is an absolute MUST that the “lay-public” be educated about what a podiatrist can do. For someone in this day and age to ask a podiatrist that question is a "Shonda" (Yiddish expression meaning something terrible).


 


Just like the AMA has done a miserable job on educating the public about the declining reimbursement, we have done a poor job regarding our education and abilities. We MUST be better at telling everyone what a podiatrist can do, and do it better than anyone else, or we will not survive. 


 


Stephen Kominsky, DPM, Washington, DC


02/03/2020    

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



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

01/31/2020    

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



From: Allen Jacobs, DPM


 


“Although lasers are approved by the FDA for onychomycosis” is not entirely correct. The FDA states that lasers may be used as adjunct therapy to supplement accepted management protocols for the treatment of onychomycosis. In fact, the FDA published policy on the matter advises not to claim that lasers are a cure for onychomycosis, but provide only temporary improvement in the appearance of the toenail. At-risk populations in which the treatment of onychomycosis is considered necessary (e.g.- diabetics, PAD patients, immunosuppressed patients) are denied appropriate treatment when lasers are employed, while subjected to potential risks.


 


The FDA approved the safety of lasers, not the specific employment of this modality for onychomycosis. And yes, while speciation is not required as lasers are not “species specific," some confirmation of fungal infection would seem appropriate prior to treatment.


 


I was evaluating a post-op Austin-Akin patient today. She told me that she watched the show. Her exact words were; “I’m impressed. I had no idea podiatrists did such complicated things.” 


 


Allen Jacobs, DPM, St. Louis, MO

01/31/2020    

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


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

01/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From:  Timothy P. Shea, DPM


 


Like other podiatrists, I have been interested in, and pleasantly pleased, by the presentation of podiatric medicine and surgery on this series. These young podiatrists present a very pleasant, personable, and professional image of our profession. This can only help to promote our image in the public arena. I know we can be a little nit-picky about topics and credentials, but recently I was approached by the chief of medical staff at one of my local hospitals about the program. He and his wife (a physician) also watch it and enjoy it very much. The key point he made to me about this series is that it presents interesting cases and good information to the public about foot and ankle care. That was a real compliment. Kudos to the stars of this show.


 


Timothy P. Shea, DPM, Concord, CA

12/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Alan L. Bass, DPM


 


I highly recommend Mike Crosby of Provider Resources, LLC. Mike has been around podiatry for many years. He provides high quality evaluations of practices. I have worked with him on a number of occasions to help clients I know to either sell or acquire practices.


 


Alan L. Bass, DPM, Manalapan, NJ

12/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Importance of Keeping up with New Medicines


From: George Jacobson, DPM


 


It is important to look up medications that you are unfamiliar with. I had a new patient who was on Truvada. Many medications have similar names. Truvada, a combination of the antiretroviral drugs tenofovir and emtricitabine, is the only FDA-approved regimen to be used as pre-exposure prophylaxis, or PrEP, against HIV. How many of us knew that medication and its indications? 


 


George Jacobson, DPM, Hollywood, FL

11/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Chris Seuferling, DPM


 


I agree with Dr. Alan Sherman's comments. In addition to biomechanics, I would add wound care to the list. In Oregon, we are trying to pass a scope bill that would allow podiatrists to treat venous stasis ulcers up to the level of tibial tubercle. During my research to gather supporting documentation to "prove" our expertise in this area, I was disappointed to find that there is nothing specific in CPME 320 regarding treatment of venous stasis ulcers, only vague generalizations. The level of training in wound care and particularly venous ulcers varies from residency to residency. This makes it difficult to convince MD/DO associations and legislators that we are "experts". 


 


I fear we are going to lose our "podiatric" identity unless we assess and standardize our residency programs to include essential elements that define our specialty.  Otherwise, podiatry will evolve solely into a backdoor route to becoming orthopedic foot and ankle surgeons. This may be okay for some, but I believe the essence of podiatry offers so much more than that to patient care and to the medical community.


 


Chris Seuferling, DPM, Portland, OR

11/28/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Gary S Smith, DPM


 



I came across advertisements from the late 1800s for snake oil and I was struck by the almost identical claims of cure by CBD oil dealers. I heard CBD oil repels giant emu attacks so I keep a bottle in my office. It works too! I haven't seen one emu!


 


Gary S Smith, DPM, Bradford, PA


11/27/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Source for CBD Oil (Jack Ressler, DPM)


From: Robert Kornfeld, DPM


 


The best medical grade CBD oil I have found comes from Canbiola, Inc. 


 


Disclosure: I am on the medical advisory board of Canbiola.


 


Robert Kornfeld, DPM, NY, NY

11/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven Selby Blanken, DPM


 


The point people miss with the name plates is that the title of all the representatives always says “Dr., Mr., Ms., Miss, or Mrs.” Name plates don’t show the degree for anyone. I’m surprised by Dr. Jacobs’ comments that may have been interpreted in a negative tone by some about Dr. Wenstrup. I am so proud of Dr. Wenstrup. I have met him and hope he is President one day. I also feel Dr. Jacobs has been a great icon in our profession.


 


Steven Selby Blanken, DPM, Silver Spring, MD

11/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Bill Beaton, DPM


 


I use DoctorDefender.com which is not a collection agency, but a collection tool that is more effective and far more affordable than collection agencies. I designed the system and had it built several years ago to help solve my personal patient collection issues and when I saw how well it worked for me. I decided to share it with other providers as an add on service through my partner's billing company, PracticeDefender.com. After two billing statements, I send a DoctorDefender notification letter for best results.


 


Disclosure: I am co-owner with PracticeDefender.com


 


Bill Beaton, DPM, Saint Petersburg, FL

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
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