non compete clause

[toe jam]

I am getting ready to leave a current employer to start my own practice about 25 miles away in a large city. The only thing stated in my non compete clause is that I can not have any paid referral source? My lawyer said he was not sure what that meant. Since paying for referrals in a medical practice in illegal and the clause itself is very vague.

The doctor of this practice said he would sue me if I treat diabetic neuropathy since it would be against my non compete clause???

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[Feli]

...My lawyer said he was not sure what that meant...

Get a more competent lawyer

 

[AGDPM]

You might want to review your state laws and any results from trail cases relating to this issue. Usually this type of contract have time limits, and geographical limits. Many state courts find this to conflict with public policy interest and may not enforce the contract. But all this could be gibberish depending on your situation. You might want to get a second opinion like Feli suggest. I just think is wrong for a fellow peer to have you refuse services to a population that is 25 miles away from them. It's not convenient for the patient especially for diabetics with neuropathy to travel that far. I listed some articles with court cases pertaining to this issue. Hope this helps and good luck.


http://jada.ada.org/cgi/content/full/136/9/1309
http://www.physiciansnews.com/law/1106rosenthal.html
http://www.ama-assn.org/amednews/2009/02/16/bica0216.htm

 

[toe jam]

Thanks for the suggestions, we will talk to another lawyer. Just wondering if anyone had an idea as to what would be considered a paid refferal source????

When we signed the contract and meet with a lawyer he stated I could set up shop right across the street if I wanted since the contract contained no time limits or no geographical limits. It only contained the that he could not have a paid refferal source.

 

[NatCh]

I am getting ready to leave a current employer to start my own practice about 25 miles away in a large city. The only thing stated in my non compete clause is that I can not have any paid referral source? My lawyer said he was not sure what that meant. Since paying for referrals in a medical practice in illegal and the clause itself is very vague.

The doctor of this practice said he would sue me if I treat diabetic neuropathy since it would be against my non compete clause???

"Paid referral source?" What on earth does that mean? Sometimes noncompete clauses state that you cannot actively recruit patients from the former practice to your new practice, but I don't know if that is what "paid referral source" refers to.

What the heck does does the employer mean by saying he would sue you if you treat diabetic neuropathy? First of all, how would he know what you are seeing any of your patients for? He does not have access to your charts and does not get to know why you are seeing anyone. Second of all, you could say you're treating the foot rather than diabetic neuropathy primarily. Third of all, the whole thing sounds bogus to me.

If the second legal opinion cannot define what "paid referral source" means then I think I would open up wherever the heck I wanted.

 

[PADPM]

I have seen and read a lot of contracts, and have never come across ONE that didn't have some geographical/time restriction. In an urban/city setting it's usually a 2 mile area and at the most a 5 mile area and the time can vary but is usually 5 years. In a suburban area, the geographical restriction is usually a little larger, from 5-10 miles.

I can only presume that the "paid referral source" may be referring to a primary care doctor who is presently capitating his/her patients to the former practice. Therefore, that PCP practice is a "paid referral source" since the DPM practice is being paid a capitation check monthly to treat the PCP's patients. I MAY be wrong, but that's the only explanation that makes any sense, since any other paid referral source in medicine is illegal.

It's awkward wording in the contract, but it's what it may mean. It may mean that the doctor leaving the practice can not take over the capitation from the PCP that was referring patients to the former practice (the "paid referral source").

As far as not having the ability to treat a particular ailment such as diabetic neuropathy, that's simply absurd and would never hold up in any court. Even if something is in a contract, it's not enforceable if it's illegal.

Not allowing you to practice your full scope of medicine or having you deny care to your patients is a restriction of trade and could compromise the care you provide to your patients. 'Ain't gonna happen.

Your former employer AND his/her attorney sound like clowns.

 

[G0dFather]

"Your former employer AND his/her attorney sound like clowns"




OH man this is a classic - bad ass comment!!

 

[PADPM]

Judging upon what the former employer and attorney wrote in the contract, it's not "bad ass comment", it's simply the truth.

 

[NatCh]

Since non-complete clauses are supposedly unenforceable in a medical practice setting, it's my understanding that employers are shifting to monetary penalties instead. For example the contract would demand $250,000 for leaving the practice then continuing to work in the predetermined area within the agreed upon time span.

 

[AGDPM]

Isn't the monetary penalty for a breach of contract? For example the employed physician decide to part-ways before his/her contracted term. Either way, a monetary penalty fee of $250,000 for a not compete clause or breach of contracted term seems a little excessive in a medical practice, no? What resources were used to employ this hypothetical physician to equal $250,000? From my understanding new practitioners don't have starting wages close to those fees. One could start-up a small practice with this fee and make their own terms, IMO.

Since I have seven years before being license to practice podiatric medicine, I'll be checking if any judicial cases favor or disfavor this penalty. I have a long way to go.

 

[NatCh]

Isn't the monetary penalty for a breach of contract? For example the employed physician decide to part-ways before his/her contracted term. Either way, a monetary penalty fee of $250,000 for a not compete clause or breach of contracted term seems a little excessive in a medical practice, no? What resources were used to employ this hypothetical physician to equal $250,000? From my understanding new practitioners don't have starting wages close to those fees. One could start-up a small practice with this fee and make their own terms, IMO.

Since I have seven years before being license to practice podiatric medicine, I'll be checking if any judicial cases favor or disfavor this penalty. I have a long way to go.

My example was just hypothetical in which I made up the number, but I have seen a multispecialty group contract in which the penalty was around $250K for continuing to practice within a 15 mile radius for 5 years. It might seem an oppressive amount but I think that's the point; it's a deterrent.

Regardless, you can make a contract stipulate whatever you want and see if the other person signs the it. Later, if it comes into question whether the terms are enforceable or not, that's when everyone lawyers up and blows a ton of money trying to clarify what the heck they agreed to in the first place.

For a relatively low earner on the physician pay scale paying $250K is nearly impossible, but for someone on the upper end of the scale (e.g., pulmonologist or oncologist) that amount might only be a few month's earnings.

The other scenario I have seen is that a competing large group will hire a physician from the other group and pay the penalty as a part of the compensation package. A big group (think Kaiser or Providence size) can absorb that kind of expense if they really want the employee.

 

[Feli]

NatCh is correct... it's hard to enforce a non-compete since judges will usually rule that the provider (who the employer is trying to kick out of the metro area) has skills that are needed for public safety. There are no absolutes, though... you will occasionally read or hear of cases where laptops/desktops/files/etc are seized to prevent docs from acquiring patient info from their old practice, doctors practicing too close to old employer are escorted out of their new office/lab by law enforcement, and non-competes are otherwise VERY toughly enforced, esp when the employer is a hospital or large group with deep legal pockets and the employee leaving is a high profit service and/or rarer specialty (cardio, ortho, neuro, academic/research doc, etc). Whether some of that stuff is lawyer legend to drum up business or not is debatable, but sometimes these things do get messy.

Since the non-competes usually won't hold up for standard small practices (who also don't want to risk a lot of legal fees trying to enforce), it seems financial penalties - either lump sum or % of income until the end of the clause - are the norm now. Those are just easier to write up and much easier to enforce... it's a dollar amount or % that's crystal clear in the contractual agreement.

 

[PADPM]

Although non-competes have been cited in the literature as sometimes not enforceable, I personally know of a few cases where the contract was upheld.

Additionally, there is one small factor many of you are forgetting. Most young doctors leaving a practice don't have deep pockets, whereas the majority of large practices certainly have deeper pockets. Therefore, even if a non compete IS NOT enforceable, it will take quite a lot of time and funds to go through the legal system to fight the contract. Most young docs leaving a practice simply don't have the resources or the time to go through this process, especially since the end result is not guaranteed.

Attorneys don't work for free and challenging the legality of a contract can be a very costly and laborious process that many young docs simply can't afford.

 

[NatCh]

Although non-competes have been cited in the literature as sometimes not enforceable, I personally know of a few cases where the contract was upheld.

Additionally, there is one small factor many of you are forgetting. Most young doctors leaving a practice don't have deep pockets, whereas the majority of large practices certainly have deeper pockets. Therefore, even if a non compete IS NOT enforceable, it will take quite a lot of time and funds to go through the legal system to fight the contract. Most young docs leaving a practice simply don't have the resources or the time to go through this process, especially since the end result is not guaranteed.

Attorneys don't work for free and challenging the legality of a contract can be a very costly and laborious process that many young docs simply can't afford.

True. I believe that the risk of monumental legal expenses related to challenging a contract is more of a factor than the legality of the contract itself. It's a lot easier to simply walk away and start over in another city.

In the case of the original poster however, if two legal opinions say it's okay to start up a practice in the vicinity of then I think I would go ahead and do it. The noncompete clauses from what he tells us sound weak or poorly written.

 

[PADPM]

In the case of the original poster, it doesn't seem there really was much of a non-compete clause. Other than my interpretation of not being able to treat patients from any former capitated providers, the other portion regarding not treating neuropathy is a no brainer. As previously stated, you can't dictate how a doctor treats his/her patients which would be denying care to a patient.

 

[NatCh]

In the case of the original poster, it doesn't seem there really was much of a non-compete clause. Other than my interpretation of not being able to treat patients from any former capitated providers, the other portion regarding not treating neuropathy is a no brainer. As previously stated, you can't dictate how a doctor treats his/her patients which would be denying care to a patient.

It was certainly an odd thing to read, wasn't it? I would love to see the actual wording of the contract.

Toe jam, would you be willing to scan that section of your contract so we can read it (just out of curiosity)?

 

[toe jam]

Once again thanks for your suggestions. In my current location I ONLY see paitents with diabetic neuropathy. ( the doctor will not allow me to see any other type of patients one of the reason I am leaving)

It is a PT that owns the clinic not a DPM but uses a certain technique to treat diabetic neuropathy that is very good. He does not want me leaving as I make him alot of money. He also has no one to replace me at what he pays me : ) and he can not treat it.

As for paid referral source I think he may mean any type of paid advertising. The equipment he uses to treat diabetic neuropathy can only be purchased through one medical rep that has the contract with the equipment company. This medical rep then pays for my employer's advertising thus being a paid refferal source.....

I am presuming since I can not buy the equipment since the medical rep can not sell it to anyother physician in a geograhical area. therefore he presumes I can not treat diabetic neuropathy the same way as I do now.

 

[hyperpodia]

Once again thanks for your suggestions. In my current location I ONLY see paitents with diabetic neuropathy. ( the doctor will not allow me to see any other type of patients one of the reason I am leaving)

It is a PT that owns the clinic not a DPM but uses a certain technique to treat diabetic neuropathy that is very good. He does not want me leaving as I make him alot of money. He also has no one to replace me at what he pays me : ) and he can not treat it.

As for paid referral source I think he may mean any type of paid advertising. The equipment he uses to treat diabetic neuropathy can only be purchased through one medical rep that has the contract with the equipment company. This medical rep then pays for my employer's advertising thus being a paid refferal source.....

I am presuming since I can not buy the equipment since the medical rep can not sell it to anyother physician in a geograhical area. therefore he presumes I can not treat diabetic neuropathy the same way as I do now.

you need to get a lawyer to represent you, and request a ridiculous amount of money to continue working for your employer that way he will have to let you go or get broke.

 

[FootDocMaryland]

uses a certain technique to treat diabetic neuropathy that is very good. He does not want me leaving as I make him alot of money. He also has no one to replace me at what he pays me : ) and he can not treat it.

As for paid referral source I think he may mean any type of paid advertising. The equipment he uses to treat diabetic neuropathy can only be purchased through one medical rep that has the contract with the equipment company. This medical rep then pays for my employer's advertising thus being a paid refferal source.....

I am presuming since I can not buy the equipment since the medical rep can not sell it to anyother physician in a geograhical area. therefore he presumes I can not treat diabetic neuropathy the same way as I do now.

What is this diabetic neuropathy "technique" ????

 

[Feli]

What is this diabetic neuropathy "technique" ????

Me guesses anodyne or some other unproven physical modality nonsense?^^

...to the OP, I think I saw an anodyne machine for sale on the QVC channel not too long ago. Maybe you can look into that?
http://www.asseenontvguys.com/light-relief.aspx

 

[PADPM]

Feli,

I usually agree with your posts, but believe you may have spoken about a modality you may not know that much about.

First let me state that I do NOT utilize anodyne therapy in our practice, but know several well known and respected colleagues who have used this modality and report excellent results. They use this in conjunction with other treatments and do not charge for the use of anodyne, therefore it is not financially motivated.

Additionally, the use of infra-red/LED therapy isn't really snake oil sales. If you do some research, you will find that our government has been utilizing different forms of this treatment modality on special force soldiers to enhance healing for several years.

There are different wave lengths, etc., and I'm not a physicist, but when used in the right application and when built correctly, I believe the use of infra-red/LED therapy can be beneficial.

I've actually read up on this for years and had an electrical engineer build me a small unit that I've used for a few years on select cases with excellent results.

Some interesting reading for you:

Combat casualty care in Special Operations already have adopted the NASA LED technology for submarines deployed in training with risk of injury. The USS Salt Lake City is currently underway with an LED Array in the Pacific. Special Operations are characterized by lightly equipped, highly mobile troops entering situations requiring optimal physical conditioning at all times. Wounds are an obvious physical risk during combat operations. Any simple and lightweight equipment that promotes wound healing and musculoskeletal rehabilitation and conditioning has potential merit. NASA LEDs have proven to stimulate wound healing at near-infrared wavelengths of 680, 730 and 880 nm in laboratory animals, and have been approved by the U.S. Food and Drug Administration (FDA) for human trials. The NASA LED arrays are light enough and mobile enough to have already flown on the Space Shuttle numerous times. LED arrays may be used for improved wound healing and treatment of problem wounds as well as speeding the return of deconditioned personnel to full duty performance. Examples include: 1. Promotion of the rate of muscle regeneration after confinement or surgery. 2. Personnel spending long periods of time aboard submarines may use LED arrays to combat muscle atrophy during relative inactivity. 3. LED arrays may be introduced early to speed wound healing in the field. Human trials have begun at the Medical College of Wisconsin, Naval Special Warfare Command, Submarine Squadron ELEVEN and NASA-Marshall Space Flight Center.

 

[Feli]

Feli,

I usually agree with your posts, but believe you may have spoken about a modality you may not know that much about.

First let me state that I do NOT utilize anodyne therapy in our practice, but know several well known and respected colleagues who have used this modality and report excellent results. They use this in conjunction with other treatments and do not charge for the use of anodyne, therefore it is not financially motivated.

Additionally, the use of infra-red therapy isn't really snake oil sales. If you do some research, you will find that our government has been utilizing different forms of this treatment modality on special force soldiers to enhance healing for several years.

There are different wave lengths, etc., and I'm not a physicist, but when used in the right application and when built correctly, I believe the use of infra-red therapy can be beneficial.

I've actually read up on this for years and had an electrical engineer build me a small unit that I've used for a few years on select cases with excellent results.

I didn't say it doesn't work. I said it's unproven.

Most physical therapy, chiro, etc modalities are largely unproven. I'm not saying they don't work, but it's nearly all subjective: the patient "feels better," "doesn't seem as edematous," "seems more stable," etc. When the most objective thing in most PT studies is the visual analog scale, that's just not enough to convince me it's not largely one big placebo effect for many of those "proven" treatment modalities (again, JMO)...
http://forums.studentdoctor.net/showthread.php?p=7077278#post7077278 (related)

...as far as Anodyne, if they come out with some well designed, non-industry sponsored, high level medical evidence with objective outcome measures (neuropathy and PAD patients' analgesic medication consumption, ambulation distance per day based on pedometer, TcPO2 readings, etc for anodyne vs placebo) which say it works better, then maybe I'll change my tune. I want to see well designed studies.

Maybe it's just the fact that my generation has EBM more ingrained into our heads from school, residency, conferences, etc? Nonetheless, until those high level peer reviewed study days arrive for Anodyne, I'll personally choose to keep it filed among orthotics, Topaz, hyperbaric oxygen, laser onychomycosis treatment, ECSW, and countless other wound care and ortho stim/bio product treatment which are huge cash generators - yet largely unproven (except if you ask the industry sponsored studies and the company's big name "consultant" speakers). Again, JMO.

http://www.ncbi.nlm.nih.gov/pubmed/17977931

I tend to subscribe to the theory that you don't want to be the first or last practitioner doing a treatment, surgery procedure, etc. If Anodyne works, it will catch on. If it doesn't, then it'll fade away just like bleeding patients, silastic implants, and alcohol sclerosing injections have. The beauty of medicine is sometimes that it's both an art and a science, but at this stage of my career, I choose to rest a bit more on the science end

 

[UncleMelvin]

I didn't say it doesn't work. I said it's unproven.

Most physical therapy, chiro, etc modalities are largely unproven. I'm not saying they don't work, but it's nearly all subjective: the patient "feels better," "doesn't seem as edematous," "seems more stable," etc. When the most objective thing in most PT studies is the visual analog scale, that's just not enough to convince me it's not largely one big placebo effect for many of those "proven" treatment modalities (again, JMO)...
http://forums.studentdoctor.net/showthread.php?p=7077278#post7077278 (related)

...as far as Anodyne, if they come out with some well designed, non-industry sponsored, high level medical evidence with objective outcome measures (neuropathy and PAD patients' analgesic medication consumption, ambulation distance per day based on pedometer, TcPO2 readings, etc for anodyne vs placebo) which say it works better, then maybe I'll change my tune. I want to see well designed studies.

Maybe it's just the fact that my generation has EBM more ingrained into our heads from school, residency, conferences, etc? Nonetheless, until those high level peer reviewed study days arrive for Anodyne, I'll personally choose to keep it filed among orthotics, Topaz, hyperbaric oxygen, laser onychomycosis treatment, ECSW, and countless other wound care and ortho stim/bio product treatment which are huge cash generators - yet largely unproven (except if you ask the industry sponsored studies and the company's big name "consultant" speakers). Again, JMO.

http://www.ncbi.nlm.nih.gov/pubmed/17977931

I tend to subscribe to the theory that you don't want to be the first or last practitioner doing a treatment, surgery procedure, etc. If Anodyne works, it will catch on. If it doesn't, then it'll fade away just like bleeding patients, silastic implants, and alcohol sclerosing injections have. The beauty of medicine is sometimes that it's both an art and a science, but at this stage of my career, I choose to rest a bit more on the science end

+1

 

[UncleMelvin]

First let me state that I do NOT utilize anodyne therapy in our practice, . . .

I've actually read up on this for years and had an electrical engineer build me a small unit that I've used for a few years on select cases with excellent results.
[/I][/B]

You either do or you don't. Which is it?

 

[PADPM]

You either do or you don't. Which is it?

First of all, as a "pre health" student, show a modicum of respect in your posts.

Secondly, simply because I had an electrical engineer build me an LED/infra-red device that I have utilized on some select patients that were friends, soccer "buddies", colleagues, etc., (and did not bill for) does not mean I used "anodyne" therapy which is a specific therapy, with a specific protocol.

So prior to asking a question, understand exactly what you are asking.

 

[UncleMelvin]

First of all, as a "pre health" student, show a modicum of respect in your posts.

Secondly, simply because I had an electrical engineer build me an LED/infra-red device that I have utilized on some select patients that were friends, soccer "buddies", colleagues, etc., (and did not bill for) does not mean I used "anodyne" therapy which is a specific therapy, with a specific protocol.

So prior to asking a question, understand exactly what you are asking.

As you're probably well aware, you've long ago lost any respect that you think you deserve. Sometimes just being older doesn't entitle you to "respect."

And you now claim to use infrared light therapy in your practice, but don't use "Anodyne" therapy. As you may or may not know, Anodyne therapy is infrared light therapy. Regardless of which protocol you choose to follow, it's unproven. It's like the osteopaths who practice cranial sacral therapy. I'm sure it brings in a few more bucks, but its garbage, and everyone knows it.

And remind me to never to play soccer with you again, buddy!

 

[PADPM]

I didn't say it doesn't work. I said it's unproven.

Most physical therapy, chiro, etc modalities are largely unproven. I'm not saying they don't work, but it's nearly all subjective: the patient "feels better," "doesn't seem as edematous," "seems more stable," etc. When the most objective thing in most PT studies is the visual analog scale, that's just not enough to convince me it's not largely one big placebo effect for many of those "proven" treatment modalities (again, JMO)...
http://forums.studentdoctor.net/showthread.php?p=7077278#post7077278 (related)

...as far as Anodyne, if they come out with some well designed, non-industry sponsored, high level medical evidence with objective outcome measures (neuropathy and PAD patients' analgesic medication consumption, ambulation distance per day based on pedometer, TcPO2 readings, etc for anodyne vs placebo) which say it works better, then maybe I'll change my tune. I want to see well designed studies.

Maybe it's just the fact that my generation has EBM more ingrained into our heads from school, residency, conferences, etc? Nonetheless, until those high level peer reviewed study days arrive for Anodyne, I'll personally choose to keep it filed among orthotics, Topaz, hyperbaric oxygen, laser onychomycosis treatment, ECSW, and countless other wound care and ortho stim/bio product treatment which are huge cash generators - yet largely unproven (except if you ask the industry sponsored studies and the company's big name "consultant" speakers). Again, JMO.

http://www.ncbi.nlm.nih.gov/pubmed/17977931

I tend to subscribe to the theory that you don't want to be the first or last practitioner doing a treatment, surgery procedure, etc. If Anodyne works, it will catch on. If it doesn't, then it'll fade away just like bleeding patients, silastic implants, and alcohol sclerosing injections have. The beauty of medicine is sometimes that it's both an art and a science, but at this stage of my career, I choose to rest a bit more on the science end

Feli,

I was waiting for this answer. The famous "evidenced based medicine" answer. However, in reality there is so much we really do on a daily basis that has not undergone the scrutiny of "EBM", yet we tend to fall back on using the excuse of EBM when a procedure, modality, medication, etc., is not something we agree with in our practice.

There have been countless studies regarding ESWT and the vast majority of these studies have shown positive outcomes (another modality I rarely utilize). Laser treatment of onychomysosis (once again something I've never performed) HAS undergone a study by Adam Landsman, DPM, Phd and his assessment was that it IS effective.

Once again, I do NOT utilize anodyne therapy in my practice, but don't necessarily believe that it's theory should be dismissed.

Additionally, I find it amusing that you state that it will fade away like silastic implants, sclerosing injections, etc. In actuality, silastic implants have NOT faded away and are still manufactured by Wright. They got a lot of bad press when patients "supposedly" had reactions to silicone particles and also received bad press secondary to dendritic synovitis from silicone shards due to wear. Then they came out with metal grommets to address that issue.

I personally do not utilize silastic implants, but you may be surprised to know of many very well known and respected "big name" surgeons who still utilize these when indicated. Although not as popular as they were when originally introduced, these still exist and are not witchcraft or analagous to "bleeding" patients.

Similarly, sclerosing alcohol injections have definitely NOT "faded" away and are also utilized by some well known and well respected DPM's. Search the literature and you will see that DPM's are now not the only profession utilizing this treatment modality. http://www.ajronline.org/cgi/content/full/188/6/1535
Dr. Gary Dockery is an extremely well known, highly published and well respected DPM who is not a "quack" who basically re-introduced sclerosing injections and would certainly not agree with your assessment that these have "faded" away.

Considering the fact you have never been in private practice, I am guessing that you have formed your strong opinions from some doctors you have been exposed to in the past. I personally believe it's a little early in your career to have formed opinions this strong, especially if your exposure to some of these treatments has been so limited.

After all my experience that I know you've read about in my prior posts, etc., I would let Dr. Dockey perform sclerosing alcohol injections on MY foot prior to undergoing "neuroma" surgery.

And while we're on the subject of EBM, etc., can you tell me of any other area in the body where there is a pathology of a nerve (such as a "Morton's neuroma"), where the nerve is simply removed such as it is in most podiatric neuroma surgical cases????

 

[PADPM]

As you're probably well aware, you've long ago lost any respect that you think you deserve. Sometimes just being older doesn't entitle you to "respect."

And you now claim to use infrared light therapy in your practice, but don't use "Anodyne" therapy. As you may or may not know, Anodyne therapy is infrared light therapy. Regardless of which protocol you choose to follow, it's unproven. It's like the osteopaths who practice cranial sacral therapy. I'm sure it brings in a few more bucks, but its garbage, and everyone knows it.

And remind me to never to play soccer with you again, buddy!

There's nothing I dislike more than a student that just doesn't get it, and I've seen many like you over my years in practice. I never said that because I'm "older" I deserve your respect.

But at your point in training (or lack of training) you should treat everyone in the profession with respect or I can GUARANTEE you that your attitude will keep you from ever succeeding. That's an ABSOLUTE guarantee.

It's easy to be brave and bold when you hide behind the computer, but it will catch up with you sooner than later.

Once again, if you read my post carefully, I NEVER ONCE STATED that I utilize LED/infra-red therapy in my practice. I DID state that I had an interest in this therapy from what I've read about the government's use of this modality,etc. As a result, I had an electrical engineer build me a small unit and I used the unit on a few select patients that agreed to it's use, at NO charge. These were friends, colleagues, etc.

And I can assure you that you're not my "buddy", and I still can't believe that someone that isn't even in a professional school and is still in "pre-health" is classless enough to actually CALL me "buddy".

You really have a LOT to learn.

 

[UncleMelvin]

Once again, if you read my post carefully, I NEVER ONCE STATED that I utilize LED/infra-red therapy in my practice.

Secondly, simply because I had an electrical engineer build me an LED/infra-red device that I have utilized on some select patients . . .

Cocaine is a helluva drug. . .

http://www.youtube.com/watch?v=9PR_rzF8ofw

 

[PADPM]

I'm not going to play this "game". You take two quotes from two different posts, out of context and don't write the complete quote. Nice try.

We have a large practice and LED therapy/infra-red therapy is NOT utilized in our practice. Because I have a personal interest in this modality, I had a few friends, colleagues and soccer buddies with ailments that I utilized this modality on to see if I would obtain results. Anyone I treat I call a "patient", though this is not a modality that is utilized by any of the partners in our practice or by me on a regular basis. It is simply something I used on a handful of people, over a short period of time, so don't take what I write out of context or try to spin it into something it's not.

Stop acting like a child.

 

[diabeticfootdr]

I didn't say it doesn't work. I said it's unproven.

I'll say it. It doesn't work. It's fine for the Hubble telescope, night vision goggles, and thermal imaging but for diabetic neuropathy it is complete hokus pokus.

Feli is right. All of the industry sponsored trials are of poor design. The only randomized, double-blind, sham-controlled trial was done by Lavery published in Diabetes Care 2008 and showed no difference between groups by any measure of neuropathy - objective, semi-objective, and subjective (NCV, VPT, SWMF, pain scales, neuropathy screening instruments, etc.)

 

[Black Surgeon]

As you're probably well aware, you've long ago lost any respect that you think you deserve. Sometimes just being older doesn't entitle you to "respect."

And you now claim to use infrared light therapy in your practice, but don't use "Anodyne" therapy. As you may or may not know, Anodyne therapy is infrared light therapy. Regardless of which protocol you choose to follow, it's unproven. It's like the osteopaths who practice cranial sacral therapy. I'm sure it brings in a few more bucks, but its garbage, and everyone knows it.

And remind me to never to play soccer with you again, buddy!

PADM, this guy is obviously a TROLL, he started a new account for the sake of insulting. Don't waste your time entertaining his idiocy.

:troll:

 

[PADPM]

I'll say it. It doesn't work. It's fine for the Hubble telescope, night vision goggles, and thermal imaging but for diabetic neuropathy it is complete hokus pokus.

Feli is right. All of the industry sponsored trials are of poor design. The only randomized, double-blind, sham-controlled trial was done by Lavery published in Diabetes Care 2008 and showed no difference between groups by any measure of neuropathy - objective, semi-objective, and subjective (NCV, VPT, SWMF, pain scales, neuropathy screening instruments, etc.)

diabeticfootdr,

Again, I am not advocating the use of Anodyne therapy, nor did I state I was a proponent of this device for diabetic neuropathy. What I did state was that I do know some well known and respected colleagues who have reported (albeit anecdotal) accounts of success with this modality in conjunction with other treatments. I believe that's exactly what I stated.

I am well aware of the studies you've cited. I have also stated that I personally have an "interest" in LED/infra-red therapy after having read many articles on it's application by our government. This was initially brought to my attention by a patient who served in one of the "special services" and asked if I had ever heard of this, and I hadn't.

So I did a little research and found it fascinating, but there were no products available on the market other than $19.95 specials. So I found some specs and had an electrical engineer built me a "protoype". Since it wasn't FDA cleared/approved I simply used this on friends, relatives, myself, etc., (though I use the term patients) and did not employ the device in our true "practice".

So, for the final time, I do not advocate Anodyne therapy, but simply stated I have colleagues who report success with this device in conjunction with other treatments. Period.

I've stated over and over again on this site that I believe Feli is extremely bright and his comments are extremely mature for his level of training. However, I believe that young practitioners sometimes can form an opinion too early on in his/her career based on the opinion of an attending(s), rather than true personal experience.

That's why I addressed the issues regarding the silastic implants and sclerosing alcohol injections. At this early stage in Feli's training, I'm not sure if he's ever been exposed to either long enough to form an opinion. Additionally, I don't believe his comments about those treatments "fading away" was really valid nor were they analagous to "bleeding patients".

 

[PADPM]

PADM, this guy is obviously a TROLL, he started a new account for the sake of insulting. Don't waste your time entertaining his idiocy.

:troll:

Thanks. You are 100% correct, and judging by some of the comments, I have a suspicion that he/she MAY be a former member who has returned.

 

[diabeticfootdr]

diabeticfootdr,

Again, I am not advocating the use of Anodyne therapy, nor did I state I was a proponent of this device for diabetic neuropathy ....

So I found some specs and had an electrical engineer built me a "protoype". Since it wasn't FDA cleared/approved I simply used this on friends, relatives, myself, etc., (though I use the term patients) and did not employ the device in our true "practice".

PADPM,

I was defending Feli because he was correct about Anodyne therapy. I'm not an expert in the other modalities that you two are arguing about, but it seems to me like he is taking a reasoned EBM approach to it.

I do, however, question why you were using a non-FDA cleared device on friends and relatives? FDA clearance or approval through PMA or 510k is required for all medical devices used and brought to market. FDA classifies devices as high, medium, and low risk. IR used for radiant heat is a medium risk device. If the device you commissioned wasn't FDA cleared, then you were experimenting on humans. That's fine as long as you had a protocol, obtained institutional review board approval, and had oversight over your research. Did you publish your results?

FYI, even if the person is a relative or friend and you prescribe anything for that person (medication or device), they become a patient. I'm sure you know that. And if the person is a relative or a friend, one could argue that you'd be prohibited from performing research on them out of possibility of coercion.

I've been a member of this forum for 6 years. You are the first person I've encountered who berates and belittles nearly everyone with an opinion different from your own. I think your presence on this forum inhibits posters from asking questions because they fear your retribution. It is not necessary and I'd ask you to please stop.

Also, you made a comment about Melvin "hiding behind his/her computer", but you do the exact same thing.

 

[michaelrack]

I am not a DPM but am interested in healthcare law and have recently consulted with a healthcare attorney about a proposed non-compete clause.

Non-competes are especially tricky when they are between physicians (MD/DO/DPM) and and non-physicians (especially non-hospital employers). In my case as sleep physician, the laws regarding the relationships between physicians and sleep labs organized as Independent Diagnostic and Testing Facilities are complex.

I would advise the OP to consult with an experienced healthcare attn, as a PT may have less legal ability to enforce a non-compete than a fellow DPM.

 

[PADPM]

PADPM,

I was defending Feli because he was correct about Anodyne therapy. I'm not an expert in the other modalities that you two are arguing about, but it seems to me like he is taking a reasoned EBM approach to it.

I do, however, question why you were using a non-FDA cleared device on friends and relatives? FDA clearance or approval through PMA or 510k is required for all medical devices used and brought to market. FDA classifies devices as high, medium, and low risk. IR used for radiant heat is a medium risk device. If the device you commissioned wasn't FDA cleared, then you were experimenting on humans. That's fine as long as you had a protocol, obtained institutional review board approval, and had oversight over your research. Did you publish your results?

FYI, even if the person is a relative or friend and you prescribe anything for that person (medication or device), they become a patient. I'm sure you know that. And if the person is a relative or a friend, one could argue that you'd be prohibited from performing research on them out of possibility of coercion.

I've been a member of this forum for 6 years. You are the first person I've encountered who berates and belittles nearly everyone with an opinion different from your own. I think your presence on this forum inhibits posters from asking questions because they fear your retribution. It is not necessary and I'd ask you to please stop.

Also, you made a comment about Melvin "hiding behind his/her computer", but you do the exact same thing.

diabeticfootdr,

Are you kidding me? You have no idea what I had "built" and it didn't differ greatly from the devices that are sold legally without the need for FDA clearance/approval. You can go to RadioShack and put some LED lights together and basically build what I have. It would hardly classify as a "medical device" and does not have nearly the same radiant capacity as an anodyne unit or medial grade units. Once again, it's identical to what's sold OTC in the stores or over the internet, except it doesn't look as pretty. I purposely kept in this way to avoid medical-legal issues. One of the "friends/patients" I utilized this device on is a healthcare attorney and I ran everything through him prior to even considering touching anyone or anything with this device.

My Dremel drill is also used "off label" for nail debridement, so please don't let the cat out of the bag.

You have a great way of twisting the truth and words. I don't berate or belittle everyone when they have a differing opinion. Nor were my posts with Feli "arguments".

I simply stated that I felt Feli may have formed his opinion based on the opinion of attendings, since at this point in his career he may not have witnessed enough silastic implants or sclerosing injections to form a true opinion. That may or may not be the case, but that's certainly not an argument nor is it "belittling or berating" Feli. And as I stated, I don't even perform silastic implants, but felt the comment needed defending.

I also stated my opinion of why I believe his comments regarding those two procedures fading away may not be valid and certainly should not be compared to "blood letting". Once again, how is that "berating and belittling" Feli?

I've posted several hundred posts on this forum, and have received many, many PM's thanking me for my honesty and for my advice. I also receive PM's on a regular basis asking me for advice and asking if our practice is looking for associates or offering rotations, etc. So I may not be as "feared" as you would like to believe.

However, you like to key in on only the posts where I express my opinion and then claim I berate and belittle someone almost everytime there is an opposing view. Sorry if that's your perception, but if I don't agree with comments that I believe are inaccurate after my years of experience and practice, I will attempt to set the record straight, especially if the opposing view is coming from someone with little or NO experience, which is often the case.

I truly question the motive of your next to last paragraph, other than being passive agressive. You write:

I've been a member of this forum for 6 years. You are the first person I've encountered who berates and belittles nearly everyone with an opinion different from your own. I think your presence on this forum inhibits posters from asking questions because they fear your retribution. It is not necessary and I'd ask you to please stop.

I see no reason for you to write that paragraph in your post. Because other than being "berating and belittling" YOURSELF towards me, you could have simply omitted that paragraph and private messaged me your concern and and asked me privately to stop, not publicly.

But then you wouldn't look like the good cop would you? Your motive is transparent.

 

[PADPM]

I am not a DPM but am interested in healthcare law and have recently consulted with a healthcare attorney about a proposed non-compete clause.

Non-competes are especially tricky when they are between physicians (MD/DO/DPM) and and non-physicians (especially non-hospital employers). In my case as sleep physician, the laws regarding the relationships between physicians and sleep labs organized as Independent Diagnostic and Testing Facilities are complex.

I would advise the OP to consult with an experienced healthcare attn, as a PT may have less legal ability to enforce a non-compete than a fellow DPM.

I would agree that it's always wise to seek the advice of a healthcare attorney and/or attorney well versed in contract law.

Our practice was faced with a unique situation. We were/are interested in hiring an associate who worked for a group with mulitple offices and a non-compete clause. Naturally, the non-compete clause stated that he/she could not practice within X amount of miles for X amount of years.

As stated, the prior group had multiple offices, many not geographically near one another. He/she only worked 2 offices, and never set foot in ANY of the other offices. Well, ONE of the other groups offices is within the "forbidden zone" of one of our offices, even though this doctor NEVER stepped foot in that office or provided patient care there.

Therefore, our group won't hire him/her since we don't want to get involved with legal issues, even though several attorneys have told us that we would PROBABLY win the case (or he/she would win the case) since the judge may enforce the restriction to only the offices he/she actually worked, but probably not offices he/she never worked.

Anyway, our attorney does not want us to have any possible exposure to a lawsuit, so until he/she gets a release or battles it out legally, we unfortunately have to pass.

 

[Feli]

...Considering the fact you have never been in private practice, I am guessing that you have formed your strong opinions from some doctors you have been exposed to in the past. I personally believe it's a little early in your career to have formed opinions this strong, especially if your exposure to some of these treatments has been so limited....

When I was rotating at a very historic and high level program, the director called on one of his first year residents during XR rounds to ask for diagnosis and procedure selection. I think it was flatfoot with arthritis or something... doesn't matter. Anyways, the resident got the diagnosis, staging, etc right, but he began to cop out of the treatment with "I don't have any experience in this surgery yet, but you could-"

The director saw what was coming: a comprehensive list of all possible surgical (and probably nonsurgical) treatments for advanced flatfoot. He cut him off at the pass: "Stop right there! You don't need experience to make a smart clinical decision. You don't!..."
(keep in mind this was a guy with thousands of F&A surgeries and dozens of good publicaitons making that above statement)
"...Most times, you just need common sense. You know the anatomy. You know the biomechanics. You know the deformities and how to fix them. So, forget telling me this 'we could' stuff! What would make sense to you here? What do YOU want to do for this patient?"

The room obviously got so quiet you could hear a pin drop, and the resident started stammering his way through a good surgical gameplan. The lesson to be learned was that sometimes we overthink things. We are highly educated, we know what the texts/literature/conferences say (assuming we read a bit), and sometimes we need to do what just makes intuitive sense. I think a major problem with podiatry (and other medical specialties) is that we have a lot of rep/financial pressure to try new things, re-invent the wheel, etc. Maybe I'm conservative, but I see no need to deviate from what works - especially when some of the new proposed treatments are rediculously expensive and make very little sense when you think them through.

For me personally (again, JMO), Anodyne makes as much sense as rubbing cinnamon between the toes of DM neuropathy pts. It's a bit pathetic to see Harkless on that video, but all he can really bring himself to say is "noninvasive device that has really no side effects" - never says it's the magic bullet they promise, but does quote their sponsored study result and say just enough to collect his "consultant" check (just as Adam Landsman did with Nomir Medical in the industry polluted laser onycho paper you reference).

Silastic MPJs or ankle implants make no sense to me when you can just do cheilectomy or ankle scope/arthrotomy (respectively) and eventually perform a well proven and time-tested arthrodesis in good position/fixation... maybe Keller/Mortons extension or Arizona brace (respectively) if the pathology's caught too late with bad osteopenia or bad compliance/comorbid surg candidate... with less cost and superior outcomes when compared to the implants, based on EBM. Alcohol sclerosing injections for inflamed nerves makes as much sense as injecting cayanne pepper eye drops into irritated eyes; that is probably a major reason the use of the alcohol neuroma treatment has dropped greatly since the reimbursement for the code went down.

...Again, the above is simply my thought process and what makes intuitive sense to me. I didn't mean to offend anyone, esp someone who I know is clearly dedicated to pod education and being one of the more conscientious posters on these forums. Discussions and debates are often how we learn best; ACFAS conferences are making the "Debate" sections (implant/fusion, base/lapidus, etc) a regular in their conferences, and Podiatry Today had featured the point/counterpoint as a longstanding column for that reasoning.

 

[diabeticfootdr]

diabeticfootdr,

Are you kidding me? You have no idea what I had "built" and it didn't differ greatly from the devices that are sold legally without the need for FDA clearance/approval. You can go to RadioShack and put some LED lights together and basically build what I have. It would hardly classify as a "medical device" and does not have nearly the same radiant capacity as an anodyne unit or medial grade units. Once again, it's identical to what's sold OTC in the stores or over the internet, except it doesn't look as pretty. I purposely kept in this way to avoid medical-legal issues. One of the "friends/patients" I utilized this device on is a healthcare attorney and I ran everything through him prior to even considering touching anyone or anything with this device.

But then you wouldn't look like the good cop would you? Your motive is transparent.

I don't have any idea what you built. But whatever it was, you built it for the purpose of treating a condition. Hence, it is defined by the government as a medical device. It doesn't matter whether it was the same or different from Anodyne. If it is sufficiently different from any other approved device it would require a Pre Market Approval (PMA) and not be allowed a 510k.

Attorneys are generally risk adverse. I can hardly believe that an attorney would review an experimental device constructed to treat a medical condition and used on humans and not see any medico-legal issues.

I'm not trying to be a "good cop". I pointed out inconsistencies in your argument and defended a comment that was grounded in evidence. It seems like you can't take the same criticisms that you deliver.

 

[PADPM]

Feli,

As always, I completely respect your points and your post and I'm glad you understand that our respective posts were simply discussions regarding our viewpoints, and certainly not criticisms or an "argument".

diabeticfootdr,

I will no longer respond to any of your posts or comments, because I know what you're all about, and I know your personal agenda. You have the uncanny ability to only focus on the details of a post that YOU want to address, but simply ignore all the other issues that you can't defend.

I really don't care what you believe. I've been at this for longer than you have and don't need you to tell me the rules of engagement and what is legally and ethically correct regarding the FDA, etc. I utilized a healthcare attorney with significant experience in this arena, and obtained his expert advice on this matter despite your "disbelief". So keep beating a dead horse.

I haven't practiced this long and stayed out of "trouble" by taking shortcuts and crossing the line, so don't start making inferences and banging your bible at me. I assure you that's a path you do not want to take.

Similar to podfather, I know your history, so we both know your true colors.

You're simply a fraud who comes on here "preaching" to be nice, but has no problem slamming me on the forum, in lieu of simply sending me a private message with your concerns. As I previously stated, the term for that is simply passive aggressive.

At this point, I would strongly recommend that you leave well enough alone.

 

[PADPM]

Feli,

I found one comment in your post of particular interest. To paraphrase your statement, you stated that it made no sense to you to inject sclerosing alcohol into an inflamed nerve (although technically a "neuroma" is a perineural fibrosis, and not necessarilty "inflamed").

However, as per one of my prior posts, does it REALLY make more sense to simply remove a nerve? Once again, you'd be hard-pressed to find another area in the body when or where there is a pathology of a nerve (other than a true tumor) where the nerve is simply removed.

The theory behind the sclerosing injections is simply to chemically destroy the segment of nerve rather than surgically removing the nerve. The end result should theoretically be similar, without the risks involved with surgical intervention.

As far as the number of sclerosing alcohol injections decreasing since the reimbursements have decreased, well that's simply a reflection of dishonest docs. If a doctor believes a procedure is beneficial and indicated, and is within the standard of care, it's certainly not morally or ethically correct to limit performing the procedure simply because you are getting less reimbursement.

I treat patients, not insurance companies and do what's best for my patients.

 

[NatCh]

Silastic MPJs or ankle implants make no sense to me when you can just do cheilectomy or ankle scope/arthrotomy (respectively) and eventually perform a well proven and time-tested arthrodesis in good position/fixation... maybe Keller/Mortons extension or Arizona brace (respectively) if the pathology's caught too late with bad osteopenia or bad compliance/comorbid surg candidate... with less cost and superior outcomes when compared to the implants, based on EBM.

[TANGENT] 1st MTPJ fusions make it difficult or impossible to put on a ski boot, so take this quality of life issue into consideration if you live in ski country and/or your patient is a skier. If you don't like Silastic you can use a metal implant. [/TANGENT]

 

[diabeticfootdr]

diabeticfootdr,

I will no longer respond to any of your posts or comments, because I know what you're all about, and I know your personal agenda. You have the uncanny ability to only focus on the details of a post that YOU want to address, but simply ignore all the other issues that you can't defend.

I really don't care what you believe. I've been at this for longer than you have and don't need you to tell me the rules of engagement and what is legally and ethically correct regarding the FDA, etc. I utilized a healthcare attorney with significant experience in this arena, and obtained his expert advice on this matter despite your "disbelief". So keep beating a dead horse.

I haven't practiced this long and stayed out of "trouble" by taking shortcuts and crossing the line, so don't start making inferences and banging your bible at me. I assure you that's a path you do not want to take.

Similar to podfather, I know your history, so we both know your true colors.

You're simply a fraud who comes on here "preaching" to be nice, but has no problem slamming me on the forum, in lieu of simply sending me a private message with your concerns. As I previously stated, the term for that is simply passive aggressive.

Everyone has a personal agenda. On this forum, mine is:
1. Support the profession of podiatry (as a whole, not a faction thereof)
2. Create awareness of the risk of amputation in diabetes and the various interventions to avoid them
3. Make young podiatrists/podiatrist to be aware of the benefits of research and publishing
4. Debunk myths

I've identified inconsistencies in your story. First you, "ran it by an attorney friend", now you "obtained expert attorney advice". Did the attorney recommend you apply for a patent? Did it infringe on another patent? Give me a break. Evaluating new devices, consulting for companies, and advising them on the diabetic foot market is what I do. Come on! You can't just create or commission a medical device in your garage and begin using it on friends and family (who as I pointed out, then become patients from a medicolegal standpoint). Then you can't claim it's not a medical device. Even tongue depressors are medical devices.

The beauty of the internet is that you can be whomever you want. You can be a 50 year old guy posing as a teenage girl, or you can be a podiatric surgeon with 20+ years experience who has sat on every board known to podiatry, performed every surgery, "invented" devices, and founded a practice that makes millions of dollars every year. There's no "credibility-check".

Some of what you on the forum makes sense and some of it seems pretty naive (like this last bit).

You slam a lot of people on the forum, usually with your 1000 word posts that start our with your supposed curriculum vitae, then proceed to damage the poster by claiming they don't have enough experience, they're only a resident/student/pre-pod so their opinion is hogwash, and if they don't reply to a specific point of yours, you harass them about it.

To be honest with you. I really don't care if someone disagrees with me. It's only an internet forum and who knows who the poster is. Everyone is entitled to their own opinion, and I at least have a shred of respect for that.

At this point, I would strongly recommend that you leave well enough alone.

Or what? We're going to take this outside the bar? Stop with the threats and the bullying.

Dealing with people like you makes me question why I'm still a member of this forum. But I've been doing it longer than you have and reply to many private messages. I don't have time to review the forum every 2 hours like you do, but I can spend a little time on the weekends replying.

I will no longer respond to any of your posts or comments ....

Okay

 

[Podfather]

Everyone has a personal agenda. On this forum, mine is:
1. Support the profession of podiatry (as a whole, not a faction thereof)
2. Create awareness of the risk of amputation in diabetes and the various interventions to avoid them
3. Make young podiatrists/podiatrist to be aware of the benefits of research and publishing
4. Debunk myths

I've identified inconsistencies in your story. First you, "ran it by an attorney friend", now you "obtained expert attorney advice". Did the attorney recommend you apply for a patent? Did it infringe on another patent? Give me a break. Evaluating new devices, consulting for companies, and advising them on the diabetic foot market is what I do. Come on! You can't just create or commission a medical device in your garage and begin using it on friends and family (who as I pointed out, then become patients from a medicolegal standpoint). Then you can't claim it's not a medical device. Even tongue depressors are medical devices.

The beauty of the internet is that you can be whomever you want. You can be a 50 year old guy posing as a teenage girl, or you can be a podiatric surgeon with 20+ years experience who has sat on every board known to podiatry, performed every surgery, "invented" devices, and founded a practice that makes millions of dollars every year. There's no "credibility-check".

Some of what you on the forum makes sense and some of it seems pretty naive (like this last bit).

You slam a lot of people on the forum, usually with your 1000 word posts that start our with your supposed curriculum vitae, then proceed to damage the poster by claiming they don't have enough experience, they're only a resident/student/pre-pod so their opinion is hogwash, and if they don't reply to a specific point of yours, you harass them about it.

To be honest with you. I really don't care if someone disagrees with me. It's only an internet forum and who knows who the poster is. Everyone is entitled to their own opinion, and I at least have a shred of respect for that.


Or what? We're going to take this outside the bar? Stop with the threats and the bullying.

Dealing with people like you makes me question why I'm still a member of this forum. But I've been doing it longer than you have and reply to many private messages. I don't have time to review the forum every 2 hours like you do, but I can spend a little time on the weekends replying.



Okay

1. Support the profession of podiatry (as a whole, not a faction thereof)
2. Create awareness of the risk of amputation in diabetes and the various interventions to avoid them
3. Make young podiatrists/podiatrist to be aware of the benefits of research and publishing
4. Debunk myths

You forgot a couple:
5. Slamming ACFAS
6. Slamming ABPS


Dealing with people like you makes me question why I'm still a member of this forum.
Sometimes it wise to take one's own advice.

I am not taking sides and have rendered my opinion when I disagreed with you, PADPM, or others. I originally started posting because of some of your posts with inaccuracies (IMO) regarding ABPS and ACFAS. I personally felt you had an agenda that would be detrimental to younger members. Now personally I could care less if you as an individual have issues with an organization(s) and you resigning was your perogative (I believe that should say it all; you do not agree with the group so you quit, again your right) but to continue to state your views when a younger person who does not know your history. the history of the organizations you slam is IMO simply wrong. PADPM can be a bit abrasive ( a problem with written comments not allowing body language or tone to be viewed) but your posts have often been negative and not pro-profession. Whether you continue to post or not is up to you. You can quit once again.

In the short term I would suggest we all chill and remember what this forum is for. Going forward, I will only comment on questions from those who want advice and will only call out people if they IMO are spreading false information about organizations, patient care, education, or the profession in general.

 

[NatCh]

Well that was messy...

 

[diabeticfootdr]

1. Support the profession of podiatry (as a whole, not a faction thereof)
2. Create awareness of the risk of amputation in diabetes and the various interventions to avoid them
3. Make young podiatrists/podiatrist to be aware of the benefits of research and publishing
4. Debunk myths

You forgot a couple:
5. Slamming ACFAS
6. Slamming ABPS


Dealing with people like you makes me question why I'm still a member of this forum.
Sometimes it wise to take one's own advice.

I am not taking sides and have rendered my opinion when I disagreed with you, PADPM, or others. I originally started posting because of some of your posts with inaccuracies (IMO) regarding ABPS and ACFAS. I personally felt you had an agenda that would be detrimental to younger members. Now personally I could care less if you as an individual have issues with an organization(s) and you resigning was your perogative (I believe that should say it all; you do not agree with the group so you quit, again your right) but to continue to state your views when a younger person who does not know your history. the history of the organizations you slam is IMO simply wrong. PADPM can be a bit abrasive ( a problem with written comments not allowing body language or tone to be viewed) but your posts have often been negative and not pro-profession. Whether you continue to post or not is up to you. You can quit once again.

In the short term I would suggest we all chill and remember what this forum is for. Going forward, I will only comment on questions from those who want advice and will only call out people if they IMO are spreading false information about organizations, patient care, education, or the profession in general.

I do not look for reasons to criticize ACFAS or ABPS. But they are not so virtuous that they deserve a free pass to avoid all criticism. You obviously like them very much and are involved in both organizations. I have resigned from both organizations and don't care for their divisiveness. The purpose of the organization is to advance the knowledge of foot & ankle surgery, advance the competence of the members, etc. Those are noble and worthwhile causes, but the organizations sometimes do this to the detriment of the rest of the profession (that is what I mean by being divisive). Their members campaign at hospitals to change bylaws and keep other non-ACFAS DPMs off staff or without surgical privileges. They refrain from using the word "podiatry" as if they're embarrassed by it. Older posts of mine have criticized their webpage for using the word not at all (or now only once in small print in the footer). Some in ABPS are seeking to remove Podiatry from their name and replace it with Foot & Ankle. How does that further the profession of podiatry? Note: there is no profession of foot and ankle surgery. My criticisms focus on their failing to support the whole profession, and just the segment that does foot and ankle surgery (and are members). Whereas APMA stands up for all podiatrists, those that perform surgery, those that don't, those that are members, those that are not.

 

[Podfather]

I do not look for reasons to criticize ACFAS or ABPS. But they are not so virtuous that they deserve a free pass to avoid all criticism.

Of course not no organization is perfect. But overall both mentioned above have done considerable good and many good individuals have donated their time to help many within the profession and their patients. I would say overall membership is pleased and we have not seen the sky is falling predicitions of the demise of ACFAS with the non affiliated status or new surgical organization.

You obviously like them very much and are involved in both organizations. I have resigned from both organizations and don't care for their divisiveness. The purpose of the organization is to advance the knowledge of foot & ankle surgery, advance the competence of the members, etc. Those are noble and worthwhile causes, but the organizations sometimes do this to the detriment of the rest of the profession (that is what I mean by being divisive).

Well that is your opinion but how by advancing surgery, research, education, and patient care can that ever be a detriment to the profession? It makes even those like you look good even without paying your dues. I am a member of the APMA even though I do not agree with all of their philosophy, rhetoric, and politics. I am not a quitter and chose to work from within and have served on committees and as an officer at the state level. I respect all ethical DPMs and do my best to help those who choose nonsurgical care as their focus obtain privileges (they are trained and experienced in), refer to them, and involve them in residency education. A team player vs well a quitter philosophy.

Their members campaign at hospitals to change bylaws and keep other non-ACFAS DPMs off staff or without surgical privileges. They refrain from using the word "podiatry" as if they're embarrassed by it. Older posts of mine have criticized their webpage for using the word not at all (or now only once in small print in the footer).

I have not seen this but if someone excludes another based upon ACFAS or APMA membership that is wrong. Board certification is typically a hospital requirement for all physicians and surgeons. Your afraid of the Podiatry word argument has already been shown to be false. Podiatry is all over the ACFAS site and you know it. Just go back and read those posts where you started out by saying it was hardly on the site and then after being called on it then state I meant on the home page.

Some in ABPS are seeking to remove Podiatry from their name and replace it with Foot & Ankle. How does that further the profession of podiatry? Note: there is no profession of foot and ankle surgery. My criticisms focus on their failing to support the whole profession, and just the segment that does foot and ankle surgery (and are members). Whereas APMA stands up for all podiatrists, those that perform surgery, those that don't, those that are members, those that are not.

Well that is the APMA's job since they represent the profession. However ACFAS's responsibility is to it's member surgeons and the public. The ABPS has the job of creating an examination process and maintaining it's integrity. As I said before there is no such thing as Podiatric surgery (like dental surgery). There is foot and ankle surgery performed by MDs, DOs, and DPMs.

 

[krabmas]

SInce this thread has gone completely off topic and is not benefitting anyone it has now been closed.