It is time for podiatry to reassess past behaviors and policies of action which are no longer viable. Suddenly, with little warning, the COVID-19 virus has impacted podiatry as it has the entire world. The effects of the current crisis are devastating enough in the short term. There is no guarantee that in 2 months, 3 months, 6 months, the virus will be contained and practices returned to normal. Normal meaning that which existed prior to this epidemic. Short term solutions, such as advanced Medicare payments, or SBA loans, kick the can down the road. The money used to float the office now is not eternal, and restitution is expected. The paycheck protection plan will not be available for 6 months or a year. It will eventually be discontinued at some point.

Rents remain due. Office personnel expect to be paid. Supplies will require ordering. Less patients will be coming to our offices now and in the future. Podiatry care is a luxury. If necessary, you can live with a bunion, a callus, a flatfoot. You cannot live with heart disease, cancer, pneumonia. Whether we as a profession like it or not, health care priorities will have to be aligned. Podiatry will not be number one, two, or ten. Private and governmental money will be scarce. Unemployed patients will lack money for co-pays or non covered services. Agoraphobia will affect many, fearful of acquiring the disorder. These are and will be REAL problems. 

Podiatrists believing that somehow they will magically become an M.D. will be relegated to mythology. Whether or not the services of a podiatrist for any given disorder ( for example ulceration care to total ankle replacement, from toenail “debridement” to the biopsy of skin lesions ) will not be an issue. With strained budgets, limited financial resources, unemployment, others capable or believing that they are capable of providing the same services will be providing those services. Urgent Care Centers, RN’s, PA’s, struggling PCP’s want and will need money also. The good times, the luxury of podiatry, will be largely over. That will be the new reality.

Happy talk and distorted views of the importance of podiatry will be of no material benefit. Talk of purple toes, diabetic ulcers, telemedicine, melanoma, ingrown toenails, will not save your practice for the next several years. 

Office sales of products for dry skin and fungus toenails ? Orthotic sales ?  Sales of “balance braces”, fake pediatric orthotics, laser toenail “surgery” ? Really ? When people are struggling to pay for food, medications, shelter, clothing, cars ?  Many were struggling prior to the pandemic. Many who benefited from the booming economy, from increased podiatry service coverages, made this profession attractive and financially rewarding. This is gone. Gone for a long time. Perhaps for all of the foreseeable future. Probably not forever, but Darwinism is at warm here.

The podiatry schools may collapse. Already struggling with low application pools, now what ?  No money, no faculty, no patients for which reimbursement can be obtained. Podiatry residencies will collapse in the  long term. Elective surgery ?  Hardly a priority.  Trauma ?  Orthopedics, which has already started an anti-podiatry pushback, will leave podiatry the uninsured trauma cases. They already have. It’s called your average residency. Fellowships ? Good luck. Podiatrists making money lying for major and not so major orthopedic device companies  ? Or pharmaceutical companies ? You had better get it in while the going was good. It is going to disappear.  $6,000 Lapidus produces now ?  $10,000 worth of external fixators ?  $1,500 a week “grafts” for scratches called ulcers ? This party will be over.  The dinner and seminar lectures are done for a long time. 

The world as we knew it has changed. Has changed forever. Podiatry as a profession does not have heard immunity in the medical population. . Happy talk, the you are important talk, the total failure of acceptance of the reality of what has occurred, is sad. It is akin to the Kubler Ross stages of dying. Denial, anger, depression, bargaining, and finally acceptance.

Short term solutions, such as attempting to upcode, fishing for more diagnoses on each patient, telemedicine, will not sustain your practice for very long. 

Some, well meaning, are trying to help. PICA will defer payments for 60 days. And then what ? How will you pay your premiums then ? And with no premiums, and a likely uptick in malpractice claims as people search for money to eat and survive, then what ?

Why CME now ? This is the least of your worries. Or it should be. Why are the state boards, state societies, APMA not petitioning for a temporary interdiction of the already bloated demands for CME ? In fact, why doesn’t the APMA offer a national program of free, I mean free, CME for the next year. Thank you Presents, IFAF, PM News, and the rest for allowing us to continue to PAY for CME. After all, if you cannot get money from the public, get it from your fellow podiatrists. Why CME now ?  Why the cost to you now ?  Will you suddenly become incompetent to treat the patients in whatever remains of your practice without 1 year of CME ? 

Dues ? Dues to what ? It’s time to deal with the reality of the costume party that has been podiatry “sub specialization”.  How’s that phony board certification doing for you now ? Or your membership in the societies such as Podiatric dermatology, pediatrics, peripheral nerve surgery, wound care, minimal incision surgery, medicine, geriatrics, and the like. How is that phony credential bringing in future patients. It will not. This would be an ideal time for ABFAS to deliver a payment holiday. There is lots of money in their coffers. Maybe the vacation meeting in Hawaii needs to stop for now. Ditto the medical board whatever they call themselves this week. APMA has millions of dollars. Millions. Maybe no dues for a year ? Sorry BOD. The party is over.

To read PM News or Podiatry Today or other junk journals you’d think all is well. The same advertisements for products and meetings. The same happy talk of shoes and orthotics and creams and lotions. About how this is a good time to change things in your office, podiatrists delivering pizzas to pharmacies and dead bodies. Nothing in the way of real advice for what you are dealing with NOW.  Just articles in both that serve their advertisers. There is a reason Podiatry Today gets thinner and thinner. There is a reason PM News gets more and more inane. At some point, advertisers and readers will come to the harsh reality that these publications have moved to the fiction section of the library. No patients, no product sales. No matter what stories the Podiatrist Barrister tells them. Or you.

As restrictions on travel loosen, there will be a temporary spike is podiatry services. If the OR time is available, there will be a mad rush to perform elective surgery. Indications and the need for such surgery will be stretched. After all, “you eat what you kill”.  Malpractice is sure to follow.  Lawyers need to eat also. Upcoding and unnecessary services will follow, with the practice management experts and the AAPPM  leading the orchestra of which you are a musician.  Audits, repayments, and fraud and abuse actions are certain to follow. Remember, private and government parties are not stupid. They will be struggling also. Pay for an intracranial mass or a CAM walker for an Austin bunionectomy ?  99213 for a bunion evaluation or a colonoscopy for possible bowel carcinoma ?  Perhaps we need a new affiliate organization, the Society of Incarcerated Podiatrist (SIP).  I’d suggest no dues for the initial 2 years. Perhaps free legal advice to members.

APMA ? No dues for 1 year. Provide online LEGITIMATE CME at NO COST for one year.

There is and will be a new reality whether you wish to accept this or not.  As they say, you can run but you cannot hide. 

Let corporations donate money for educational support, but have NO influence on content. Anyone with any investment of any type in sponsoring corporations, not permitted to speak. 

State societies : We probably need them pay your dues. (APMA: grant a reprieve from the pay one pay all policy)

PICA: Not certain what you can do. Difficult  situation. 

You need malpractice. You can lower premiums by giving up surgery. It’s not worth the money unless you are a whore for an orthopedic supplier. Let the three year resident/fellow/super surgeons spend all day in the OR and the next 90 days with these patients. You will have less risk and a lower premium.

ABFAS: No dues for one year.  Or a substantial reduction in dues until thing improve.

ACFAS: Consider free online CME for one year. Reduce dues for one year. Corporate grants but NO corporate influence over speakers. Those invested in any manner not permitted to speak. Do it online.

APMA affiliate organization: No dues to these organizations that basically line the pockets of a few. Why pay them now ? What possible benefit are they to you ?  When things get better, and for many they will, rejoin later.

PM News and Podiatry Today: Stop the stupid articles of no help to hurting practitioners. Stop articles which are clearly meant to serve what will be your declining pool of advertisers. Print material of true value relevant to what podiatrists are actually facing.  TAL vs. gastric recession ?  Pills that claim to cure neuropathy ?  Not much value without patients.

Society of Incarcerated Podiatrists (SIP) ?  Join now.  Special initiation fee of $50. Certificate of certification included.  AAPPM members grandfathered in at no charge.

At some point, we will hopefully return to the new normal. You will return to a reasonable practice. The economy will recover, and the luxury of podiatry care will be resurrected for the survivors. At that point, if we choose, we can return to CME seminars, APMA dues, joining worthless APMA affiliated organizations, payment to keep your board certification. The parasitic species of this profession can return to their parasitic ways. Office sales of unproven and invalidated creams and lotions, balance braces and orthotics can return. But as in any case of heard immunity, some will not survive.

This is a time for cooperative efforts from between podiatrists to TRULY help each other through this crisis. It is time for once, to temporarily set aside self serving actions. Everything discussed can be easily achieved. 

It’s time to circle the wagons, protect the women and children, take out the guns and rifles, and defend our profession. Now you will see who really cares, and who is incapable of any altruistic action.

I hope for the former to prevail.