Relevancy of PM News

[NatCh]

...lest you twist a finger muscle!

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[ExperiencedDPM]

...lest you twist a finger muscle!

Never happens when you warm up AFTER your activity.

 

[HardRoadPaved]

 

[heybrother]

 

[Hybrocure]

View attachment 383036

He’s cash pay. Why test anything?

 

[GreenHousePub]

For once Ivar speaks some sense

 

[Adam Smasher]

I've caught flak on here for testing nails on my lamisil patients, but there's enough past controversy surrounding this drug that it makes medical-legal sense in my mind to do it. Also, if you strongly believe that it's not fungus, testing is very useful for convincing patients they don't need to be using drugs (oral or topical).

However, 60% is a very low number. I have a data set of my own where my positivity rate was 75%.

 

[ExperiencedDPM]

It truly doesn’t get any better than this post by esteemed Ivar Roth, DPM.

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02/28/2024 Ivar Roth, DPM, MPH

FL Podiatrist Published in Journal of Fungi (Allen Jacobs, DPM)

Thanks Dr. Jacobs for your comments. With my
concierge practice I take the time to treat each
patient personally and follow them up very
carefully. When I say follow up for fungus nail
treatments, I include a 3 month follow-up as well
as a 12 month at no charge. Since the patients
paid significant funds, we have a high number that
return for their follow up appt. We take photos
100% of the time at each visit during the
treatment and with follow-ups. I have spent over 2
decades trying to cure fungus toenails and I can
say with great pride that I have achieved that
goal. I have successfully treated thousands of
patents now. When I say cured I mean cured. I use
a 4-step process.

The first is using a laser or lasers which I have
developed a proprietary protocol for. It took me
years to figure out what settings and times to
use. The second step is meticulous nail care where
the offending fungus nails are debrided maximally
and re shaped from sometimes as bad as horses
hoofs to perfect nails again, this is done
throughout the treatment program. All the nails
that the medical profession says cannot be cured I
cure. Look at my yelp reviews. The third step is
use of my proprietary kit which includes using a
gel I developed and that is made at a compounding
pharmacy as well as drying the nails with a hair
dryer which you earlier were critical of. The last
step is using a nail stimulant to grow the nails
quicker with a propriety combination of mini doses
of antifungals.

I am currently looking for funding to apply for a
FDA “cure” status which as you stated would be
worthy of a Nobel Prize in your estimation. I have
developed an algorithm based on the how the nails
present themselves so that if there is
noncompliance or a problem in one area you just
follow the algorithm for an alternate pathway to
success.

Dr. Jacobs, I invite you to come see the daily
miracles that I perform here at my office to see
for yourself of course with a signed NDA. I want
very much to bring this cure to our profession so
that we can add some shine to the profession of
podiatry as the experts for this problem.

Ivar E. Roth, DPM, MPH, Newport Beach, CA​

 

[Hybrocure]

It truly doesn’t get any better than this post by esteemed Ivar Roth, DPM.

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I want to write a witty statement, but I keep backtracking and deleting everything I type in response to this because it’s just so unbelievable.

All I can say, is thank god this guy runs a cash only practice.

 

[Feli]

I want to write a witty statement, but I keep backtracking and deleting everything I type in response to this because it’s just so unbelievable.

All I can say, is thank god this guy runs a cash only practice.

You mean to say you don't tell patients to dry toenails with a hair dryer?

Try shadowing Dr. Ruth in the office to see for yourself. It may then be listed on one's CV as a fellowship... if you sign the NDA, of course.

...I am worried our esteemed mycological master of the 4-step might be opening himself up a class-action lawsuit. "As bad as horses' hoofs" is going to leave many horses and their owners shocked and chagrined, mortified and stupefied. It's outrageous, egregious, preposterous. It's definitely preposterous.

 

[dtrack22]

It truly doesn’t get any better than this post by esteemed Ivar Roth, DPM.

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[Hybrocure]

You mean to say you don't tell patients to dry toenails with a hair dryer?

Try shadowing Dr. Ruth in the office to see for yourself. It may then be listed on one's CV as a fellowship... if you sign the NDA, of course.

...I am worried our esteemed mycological master of the 4-step might be opening himself up a class-action lawsuit. "As bad as horses' hoofs" is going to leave many horses and their owners shocked and chagrined, mortified and stupefied. It's outrageous, egregious, preposterous. It's definitely preposterous.

That’s the thing. Can there even be a lawsuit if it’s cash pay?

 

[BubbaWub]

It truly doesn’t get any better than this post by esteemed Ivar Roth, DPM.

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I hope to have the prestige of Dr. Roth one day. Our practices are quite similar, however I am not cash pay. Still working on my employer to switch to RVUs.

Thank you

 

[air bud]

I've caught flak on here for testing nails on my lamisil patients, but there's enough past controversy surrounding this drug that it makes medical-legal sense in my mind to do it. Also, if you strongly believe that it's not fungus, testing is very useful for convincing patients they don't need to be using drugs (oral or topical).

However, 60% is a very low number. I have a data set of my own where my positivity rate was 75%.

I don't want to be the literature guy here...but I don't think there is any even semi recent controversy? The only study I know about showed you had to have double normal LFT for it to be an issue. Read the following with the mean girls meme in mind "Quit trying to make elevated LFTs from lamisil a thing"

 

[Adam Smasher]

I don't think there is any even semi recent controversy

Many PCPs in my area refer to lamisil as "the drug that kills your liver," YMMV

Edit: also, not that I want to be the literature guy either, but the literature is very much in favor of testing

 

[air bud]

Many PCPs in my area refer to lamisil as "the drug that kills your liver," YMMV

Edit: also, not that I want to be the literature guy either, but the literature is very much in favor of testing

I am going to assume you are right, quoting literature is not a hill I want to die on.

 

[ExperiencedDPM]

Just when I thought comments couldn’t get more ignorant. The last sentence left me speechless.


st Published in Journal of Fungi (William Scherer, DPM)
From: Brett Ribotsky, DPM

Three observations/comments I need to make on this topic:

1) Incredible accolades should go to Dr. Scherer for being the most published podiatrist ever on onychomycosis, including winning three Stickel awards. Currently, this paper written with Dr. Gupta (The world authority on onychomycosis) should be acknowledged, and respected by all of us.

2) I am shocked that Dr. Markinson, who is a podiatric expert on dermatolgy, could not find 5 to 10 minutes out of his day to read the article that Drs. Scherer/Gupta authored.

3) To Dr. Roth, I am incredibly excited on what you may have discovered. I’m willing to offer you $10 million plus royalties for the right to distribute this product, should it prove its success unequivocally. Onychomycosis is the number one disease in the world and should your treatment algorithm be reproducible and successful, it may be a greater invention than insulin.

Brett Ribotsky, DPM, Fort Lauderdale, FL

 

[Hybrocure]

Just when I thought comments couldn’t get more ignorant. The last sentence left me speechless.


st Published in Journal of Fungi (William Scherer, DPM)
From: Brett Ribotsky, DPM

Three observations/comments I need to make on this topic:

1) Incredible accolades should go to Dr. Scherer for being the most published podiatrist ever on onychomycosis, including winning three Stickel awards. Currently, this paper written with Dr. Gupta (The world authority on onychomycosis) should be acknowledged, and respected by all of us.

2) I am shocked that Dr. Markinson, who is a podiatric expert on dermatolgy, could not find 5 to 10 minutes out of his day to read the article that Drs. Scherer/Gupta authored.

3) To Dr. Roth, I am incredibly excited on what you may have discovered. I’m willing to offer you $10 million plus royalties for the right to distribute this product, should it prove its success unequivocally. Onychomycosis is the number one disease in the world and should your treatment algorithm be reproducible and successful, it may be a greater invention than insulin.

Brett Ribotsky, DPM, Fort Lauderdale, FL

I wonder how they’re all scaring their patients into treating a relatively harmless condition. I’d like to know the line of dialogue these guys use to sell these cash pay options to their patients.

I have a hard enough time trying to convince my patients to pay for a topical after insurance..

 

[HardRoadPaved]

This is the SDN version of 'ok you had your fun folks'

 

[Hybrocure]

View attachment 383402

This is the SDN version of 'ok you had your fun folks'

It’s the PM News version of the lawyers called

 

[ExperiencedDPM]

It’s amazing that Udell and Roth don’t even know they are the laughing stock of the profession. They just keep digging a deeper hole.

 

[air bud]

View attachment 383402

This is the SDN version of 'ok you had your fun folks'

Closing

 

[Adam Smasher]

It’s amazing that Udell and Roth don’t even know they are the laughing stock of the profession. They just keep digging a deeper hole.

What is the difference between denial and lack of insight?

Denial and lack of insight are different. They can both cause a person with dementia not to understand or accept their diagnosis.

www.alzheimers.org.uk

 

[Hybrocure]

It’s amazing that Udell and Roth don’t even know they are the laughing stock of the profession. They just keep digging a deeper hole.

What is the difference between denial and lack of insight?

Denial and lack of insight are different. They can both cause a person with dementia not to understand or accept their diagnosis.

www.alzheimers.org.uk

View attachment 383425

It’s not that. We all know old docs like this. They think they’re the king of the world and the main character every place they go. Decades of owning a successful private practice goes to their heads. And at the end of the day should they even care? Idk. They’re rich lol

 

[ExperiencedDPM]

It’s not that. We all know old docs like this. They think they’re the king of the world and the main character every place they go. Decades of owning a successful private practice goes to their heads. And at the end of the day should they even care? Idk. They’re rich lol

I assure you Udell isn’t rich.

 

[Retrograde_Nail]

This PMnews post is rather disturbing to me. This guy is considered a leader in the profession but this is a delusional post. Foot and ankle surgery is already a sub specialty in MD/DO. It’s called orthopedic foot and ankle surgery.

If this is how leadership thinks then there is a reason nothing gets done.

 

[eyeeye_captain]

This PMnews post is rather disturbing to me. This guy is considered a leader in the profession but this is a delusional post. Foot and ankle surgery is already a sub specialty in MD/DO. It’s called orthopedic foot and ankle surgery.

If this is how leadership thinks then there is a reason nothing gets done.

View attachment 384346

See guys? I’m out here building bridges.

I have no clue what this guy is talking about. Our system is relatively unique, but it’s not similar to CAQs. My understanding is that this is a board designation of a subspecialty. Sadly, I’m not a board certified or qualified vitreoretinal surgeon. Why? Because they don’t exist. We actually have 2 boards (bet you didn’t know, maybe I’ll touch on it in the single board thread), and neither grants anything past general certification.

The reason I said unique is that our residencies are ACGME regulated, but the vast majority of fellowships are not (only oculoplastics are). That may be why the boards have not made distinctions, but I doubt it’s a model most of you would like to have. I guess we could make subspecialty boards, but that’d be less than fun.

 

[air bud]

See guys? I’m out here building bridges.

I have no clue what this guy is talking about. Our system is relatively unique, but it’s not similar to CAQs. My understanding is that this is a board designation of a subspecialty. Sadly, I’m not a board certified or qualified vitreoretinal surgeon. Why? Because they don’t exist. We actually have 2 boards (bet you didn’t know, maybe I’ll touch on it in the single board thread), and neither grants anything past general certification.

The reason I said unique is that our residencies are ACGME regulated, but the vast majority of fellowships are not (only oculoplastics are). That may be why the boards have not made distinctions, but I doubt it’s a model most of you would like to have. I guess we could make subspecialty boards, but that’d be less than fun.

We're not real doctors. End of discussion.

 

[ReaganomicsLamborghini]

This PMnews post is rather disturbing to me. This guy is considered a leader in the profession but this is a delusional post. Foot and ankle surgery is already a sub specialty in MD/DO. It’s called orthopedic foot and ankle surgery.

If this is how leadership thinks then there is a reason nothing gets done.

View attachment 384346

It’s actually not such a terrible idea. If the goal is “parity” then just eliminate the DPM degree altogether and see if allopathic medicine would be willing to absorb podiatry as another speciality. Orthopedic foot and ankle surgery and Podiatry coexist under separate degrees, maybe they could still coexist under the same degree. “Parity” can never happen with the DPM. Alternatively if we stay DPMs cut training time shorter and graduate less DPMs, but that won’t happen.

 

[footshazam]

It’s actually not such a terrible idea. If the goal is “parity” then just eliminate the DPM degree altogether and see if allopathic medicine would be willing to absorb podiatry as another speciality. Orthopedic foot and ankle surgery and Podiatry coexist under separate degrees, maybe they could still coexist under the same degree. “Parity” can never happen with the DPM. Alternatively if we stay DPMs cut training time shorter and graduate less DPMs, but that won’t happen.

I think it’s a good idea for DPM to be put under allopathic medicine’s umbrella. Some thing has to give at this point with half full classes. I think they literally have no choice. Plus isn’t the guy who mentioned it a huge podiatry name? or is his last name just the same as the big podiatry guy, I’m not sure. They also will have to change the curriculum to meet the standards.

 

[Hybrocure]

It’s actually not such a terrible idea. If the goal is “parity” then just eliminate the DPM degree altogether and see if allopathic medicine would be willing to absorb podiatry as another speciality. Orthopedic foot and ankle surgery and Podiatry coexist under separate degrees, maybe they could still coexist under the same degree. “Parity” can never happen with the DPM. Alternatively if we stay DPMs cut training time shorter and graduate less DPMs, but that won’t happen.

GL w that. MDs/DOs will never grandfather their degree to us lol. And rightly so we don’t deserve to be called MD or DO. MDs and DOs have enough drama between each other as it is let alone us ankle biters

 

[Adam Smasher]

I've said it before and I'll say it again, the main motivation behind the push for parity is coming from podiatrists who ultimately don't want to practice podiatry.

 

[Feli]

I think it’s a good idea for DPM to be put under allopathic medicine’s umbrella. Some thing has to give at this point with half full classes. I think they literally have no choice. Plus isn’t the guy who mentioned it a huge podiatry name? or is his last name just the same as the big podiatry guy, I’m not sure. They also will have to change the curriculum to meet the standards.

MDs have no need for podiatry, though (aside from the nail clip part... which nurses/tech can do).

Between ortho (bone/joint/sports) and derm (skin/nail) and gen/vasc surg (wounds/amps), they have the foot covered.

If anything, podiatry for MDs would have to be a 3yr match to do non-op (wounds/office), and that would not be very popular because it's so limited (compared to being a FP... and having those wound/foot things still in scope anyways).

...Saxena was a bigger name in podiatry sports med for awhile. He ran a fellowship and is in the twilight of his career; he's accomplished a lot - but badly missed the mark on this issue... as @Retrograde_Nail hit on. Most of the people pushing for pod students to do more medicine rotations or longer residency or take USMLE or do fellowships or whatever are typically decades removed from those student days themselves. They have no skin in the game... nothing to lose. They're just talking.

I've said it before and I'll say it again, the main motivation behind the push for parity is coming from podiatrists who ultimately don't want to practice podiatry.

I wouldn't say they don't want to practice, but they are far removed from training.
They have nothing to lose by making younger DPM students, residents, (now fellows!), etc take on longer training, more debt, more tests, more hurdles.

We see it every year.

...Alternatively if we stay DPMs cut training time shorter and graduate less DPMs, but that won’t happen.

Get this guy outta here.^
Jublia and Sketchers won't pay as much for their APMA seal of approval if there aren't 600+ DPMs coming out yearly, sir.

 

[Retrograde_Nail]

It’s actually not such a terrible idea. If the goal is “parity” then just eliminate the DPM degree altogether and see if allopathic medicine would be willing to absorb podiatry as another speciality. Orthopedic foot and ankle surgery and Podiatry coexist under separate degrees, maybe they could still coexist under the same degree. “Parity” can never happen with the DPM. Alternatively if we stay DPMs cut training time shorter and graduate less DPMs, but that won’t happen.

It's a terrible idea. MD/DO have no use for us. We are seeing nurses performing routine foot care. MD/DO can handle the foot if they really wanted to...but they don't. So they keep us around to dump on us.

All the ankles I get have diabetes, PVD, HIV, homeless, 300lbs, drug user or are geriatric.

We serve the purpose of doing anything and everything nobody else wants to do.

 

[ReaganomicsLamborghini]

It's a terrible idea. MD/DO have no use for us. We are seeing nurses performing routine foot care. MD/DO can handle the foot if they really wanted to...but they don't. So they keep us around to dump on us.

All the ankles I get have diabetes, PVD, HIV, homeless, 300lbs, drug user or are geriatric.

We serve the purpose of doing anything and everything nobody else wants to do.

I’m not really for this but if parity is what they really want this would be the only hope. If it doesn’t work out, give up on the parity delusion. What I’m really for is podiatry offering multiple options under the podiatry umbrella, not everyone wants to be a surgeon, not everyone wants to train 7 years for a limited license, people should have options. Have a different entrance exam for podiatry and find students who are actually interested, no point in accepting the MCAT if everyone is scoring in the bottom 20th percentile. This profession needs a new strategy.

 

[Adam Smasher]

What I’m really for is podiatry offering multiple options under the podiatry umbrella, not everyone wants to be a surgeon, not everyone wants to train 7 years for a limited license, people should have options.

I generally like this suggestion but dislike the end result. I've written approvingly in the past about how in Australia, a DPM is a 3-year degree with no residency requirement if you're non-surgical. Makes sense to me, I use my ankle training as much as I use organic chem. The problem of course is that we're always judged by the weakest among us, and if we create a lower tier of dpms, that's who we'll be judged by.

 

[ReaganomicsLamborghini]

I generally like this suggestion but dislike the end result. I've written approvingly in the past about how in Australia, a DPM is a 3-year degree with no residency requirement if you're non-surgical. Makes sense to me, I use my ankle training as much as I use organic chem. The problem of course is that we're always judged by the weakest among us, and if we create a lower tier of dpms, that's who we'll be judged by.

Unfortunately true.

 

[footshazam]

Thanks for the responses but it seems to me that something has got to give in the situation. I’m not sure what but it’s got to be done.

Did anybody else read on PM News that Temple has been issued notice/warning about them needed to be independently financed (is what I assumed the person who commented meant) and not backed by the University anymore. To me that spells big trouble if enrollment is down at all the schools. But what do I know…

 

[Feli]

I generally like this suggestion but dislike the end result. I've written approvingly in the past about how in Australia, a DPM is a 3-year degree with no residency requirement if you're non-surgical. Makes sense to me, I use my ankle training as much as I use organic chem. The problem of course is that we're always judged by the weakest among us, and if we create a lower tier of dpms, that's who we'll be judged by.

I don't think this is the case.
We are only judged by lowest common denominator if we try to say all DPMs are equal in training/competence (which we foolishly try right now).

Podiatry missed the boat badly on not having basic primary care podiatrists and surgical trained DPMs (dental model).

For any podiatrist who does a lot of surgery, they get most of their referrals from rep (PCPs and group) and from other DPMs (who don't have training and/or setup to do the surgery). The only ones who need to understand our training is ourselves... like a general dental office, who refers to peds, OMFS, perio, etc.

 

[ReaganomicsLamborghini]

I don't think this is the case.
We are only judged by lowest common denominator if we try to say all DPMs are equal in training/competence (which we foolishly try right now).

Podiatry missed the boat badly on not having basic primary care podiatrists and surgical trained DPMs (dental model).

For any podiatrist who does a lot of surgery, they get most of their referrals from rep (PCPs and group) and from other DPMs (who don't have training and/or setup to do the surgery). The only ones who need to understand our training is ourselves... like a general dental office, who refers to peds, OMFS, perio, etc.

OMFS also become DDS, MD. The dental
model makes so much more sense.

 

[Feli]

OMFS also become DDS, MD. The dental
model makes so much more sense.

Yep, and they have to take and pass step 1 upon matching OMFS.

Podiatry could potentially be the same... it would be the upper crust pod students matching surgery, who should have good study habits and aptitude. The MD/USMLE part is obviously not needed, but we need tiered system for surgery and general DPMs asap.

The years of 'podiatrist is a podiatrist' and 'all podiatrists do 3 year surgical residency' are to our detriment. Saturation is irreversible at this point. The job market is absolutely flooded from coast to coast. It's a huge failing by podiatry leadership and pod schools. It forces many people into residencies which are inadequate. The job market is very rough with poor ROI and few location choices - even with good or elite current podiatry training. It should not have been hard to see coming that branding all podiatrists surgical was not realistic, and we also didn't have the residencies or the public need for it. It was never there. It was a pod school and APMA marketing thing all along. It still is.

USA simply doesn't need so many foot surgeons, too many DPMs aren't trained well for surgery and complex cases, and some DPMs don't even want to do surgery. It would be much better to have a limited number of DPMs doing the surgery (prob 20% or less of grads)... they'd have much better training, better job market, much better volume, better results. It works in the dental world: they sort out their specialist refers fine, and their surgeons are in demand... not mediocre trained and struggling for jobs and doing 2 or 3 surgeries per month while making $150k for $400k student debt like many podiatrists are.

 

[Adam Smasher]

As long as we're fantasizing about 2-tier systems--and make no mistake, these are fantasies--how about they invent "podiatric physician assistant?" Let the DPM stay on a 7-year track but convert some of the pod school seats to Masters degrees ("MPM?") and fast-track your way into a clinical setting working in collaboration with a DPM.

The ROI might very well favor the Masters, hahaha

 

[Hybrocure]

Is there a podiatry mafia we don’t know about? Who are the podiatry families?

 

[HardRoadPaved]

Is there a podiatry mafia we don’t know about? Who are the podiatry families?

View attachment 385526

The same families that hire you at 100k and tell you as part of the family you need call 3 weekends a month

 

[Bored Snorlax]

Is there a podiatry mafia we don’t know about? Who are the podiatry families?

View attachment 385526

Dr Lepow, first of his name, lord of the metatarsals, and protector of the realm of podiatry. Let’s hope the next in line can fill his shoes

 

[LossToFollowUp]

Yep, and they have to take and pass step 1 upon matching OMFS.

Podiatry could potentially be the same... it would be the upper crust pod students matching surgery, who should have good study habits and aptitude. The MD/USMLE part is obviously not needed, but we need tiered system for surgery and general DPMs asap.

The years of 'podiatrist is a podiatrist' and 'all podiatrists do 3 year surgical residency' are to our detriment. Saturation is irreversible at this point. The job market is absolutely flooded from coast to coast. It's a huge failing by podiatry leadership and pod schools. It forces many people into residencies which are inadequate. The job market is very rough with poor ROI and few location choices - even with good or elite current podiatry training. It should not have been hard to see coming that branding all podiatrists surgical was not realistic, and we also didn't have the residencies or the public need for it. It was never there. It was a pod school and APMA marketing thing all along. It still is.

USA simply doesn't need so many foot surgeons, too many DPMs aren't trained well for surgery and complex cases, and some DPMs don't even want to do surgery. It would be much better to have a limited number of DPMs doing the surgery (prob 20% or less of grads)... they'd have much better training, better job market, much better volume, better results. It works in the dental world: they sort out their specialist refers fine, and their surgeons are in demand... not mediocre trained and struggling for jobs and doing 2 or 3 surgeries per month while making $150k for $400k student debt like many podiatrists are.

Exactly this. We need to funnel training to people that will actually use it. I'm sure we all know peers that went to kick-ass programs but ended up non-surgical. I haven't met a single surgical specialty not practice to the fullest of their ability. Only in podiatry you go through all that and go, "not for me."

We should not be graduating anywhere near the number of ortho grads a year. If they are graduating 700, then we need to be in 200-300s.

 

[Feli]

Dr Lepow, first of his name, lord of the metatarsals, and protector of the realm of podiatry. Let’s hope the next in line can fill his shoes

Also the family with one of the only ppl not smart enough to walk out and quit on ABPM nonsense last year.

Exactly this. We need to funnel training to people that will actually use it...

You don't consider each average DPM doing 9.2 bunion surgery and 1.8 ankle orif and 0.8 Achilles repairs per year a good thing?

 

[Bored Snorlax]

Also the family with one of the only ppl not smart enough to walk out and quit on ABPM nonsense last year.


You don't consider each average DPM doing 9.2 bunion surgery and 1.8 ankle orif and 0.8 Achilles repairs per year a good thing?

House Lepow is known for their loyalty.

 

[LossToFollowUp]

You don't consider each average DPM doing 9.2 bunion surgery and 1.8 ankle orif and 0.8 Achilles repairs per year a good thing?

I'm talking about real training. Not VA training!

 

[Hybrocure]

House Lepow is known for their loyalty.

Ok maybe I’m a fan of house Lepow then.