Acceptance Address APMA House of Delegates Washington, DC

Michael J. King, DPM

President

American Podiatric Medical Association

2011–2012

Dr. Speaker, Madam President, members of the board, APMA staff, distinguished past presidents, guests, friends, and family, it is with great pride and humility that I stand here today as the 85^th president of the American Podiatric Medical Association.

I am going to hold off until later the thanks and recognition of family as I am a very emotional person when it comes to my family and friends. I have many to acknowledge and thank.

I have the honor of following many great leaders of our association, several of whom have been a mentor to me. I know, thanks to them, that I have learned the lessons of leadership well.

These are trying times in the practice of medicine. Insurance overregulation, struggling economy, medical tort issues, and a world of medical technology are changing the dynamics of our practices. We have our work cut out for us. But, I have no doubt we are fully up to the task. Your APMA, its members, and you are the most qualified and best prepared team in history.

I am one of you, a member, prepared to serve. Today I will draw on my favorite motivational mantra, “Leaders Are. . ..” I will also tie together some motivational quotes with my plan for moving this association forward in history.

Leaders are. . .both confident and modest

I am confident that with your help we are prepared to move this association to the next level. The cohesiveness of this profession; the confidence of this profession, and the preparedness of this profession have never been greater. Yes, we have work to do. Yes, we have our issues: dues increase, discrimination of payers, Title XIX, and others, but I can say with confidence that we are the best prepared of any major medical organization to meet the challenges ahead. Other medical associations are envious of our percentage of membership, of our PAC, and of our ability to affect significant change in both Congress and with insurers, despite our comparatively small size. In our preparedness we are always striving for better while maintaining humility in our successes. That is being both modest and honest.

Leaders are. . .authentic

The transparency with which APMA functions today is greater than ever. The budgetary process is seamless and see-through. It is both open to debate and adjustment; both of which we will undoubtedly have at this House of Delegates. It is public and open for all members to see.

Despite some who may think so, there is no outrageous swag for this Board of Trustees. The days of “Mad Men”-era perks are over. This is a hard-working group of leaders who sacrifice daily for the betterment of this profession and this association. Transparency is of great importance today, and our transparency reflects the authenticity we are committed to.

Leaders are. . .good listeners and observant

“The majority of individuals view their surroundings with a minimal amount of observational effort. They are unaware of the rich tapestry of details that surrounds them, such as the subtle movement of a person’s hand or foot that might betray his thoughts or intentions.”(anonymous)

Your board and I are APMA’s eyes and ears. We are constantly lying with our ears on the proverbial train tracks for the next train to ride to success. We listen to the concerns of the membership and make sure we address those concerns to the best of our ability while suggesting what we feel is best for the association’s business.

Prioritizing and learning to choose one’s battles becomes a big issue at this level of leadership. No one wants to waste any of our precious resources, which you the member have provided us through your dues dollars. Sometimes the priorities of some are not the priorities of the majority, and tough choices must be made. These choices are not made in a vacuum or to give deference to any one person or group. The choices are made in a clear and well–thought-out manner, to serve the greater good of the membership. We are always seeking answers to members’ questions. No, we don’t always get the answers we want from the insurers, or from Congress, but that does not mean we are not seeking answers, and sometimes the answers we get and give just don’t seem fair.

Leaders are. . .good at giving encouragement and they are never satisfied

Believe me, it is no treat to tell members when the RUC has cut fees, when insurance discrimination seems to have no fix, or that we need more money to effectively run this association. But, I assure you, we are always trying to make positive changes and never give up trying to move the association in a positive direction. It is the perseverance and patience needed to continue the fight for Title XIX, the universal designation as physician, and our rightful place in medicine with parity.

To never be satisfied often means sacrifices must be made at the personal and professional level. The reason you are all sitting here today is because you are not satisfied with the status quo; you are here to make a difference—and you do!

Never being satisfied means planning. One of the major goals I have this year is through our strategic planning process and the strategic planning meeting we have scheduled for this May. We need to once again look at the direction of this association for both the long and short term.

Brian Tracy, motivational speaker, said, “people with clear, written goals accomplish far more in a shorter period of time than people without them could ever imagine.”

Leaders. . .provide direction

The strategic planning process allows us to direct the future of APMA into areas such as Vision 2015, legislative advocacy, and enhancement of young members’ involvement. We need to look at the role of the affiliates, and the students and to prepare ourselves for practice changing implementation of ICD 10. We need to continue to look for better ways to ensure our proper place in organized medicine. Our continued incorporation into the whole of organized medicine is paramount to our survival. We cannot allow ourselves to be marginalized. With ACOs coming into play in the near future, we must be assured of our place in the accountable-care scheme.

Will that require a deeper look into Title XVIII and the 1861r designation? Will that require even more involvement from the grassroots of podiatry? Yes, and we will continue to investigate these approaches.

We need to look at where we are and where we must go in our current number one strategic area: Vision 2015. Vision 2015 has come a long way since the resolution in this house led to its development. The stakeholders have met, planned, battled a little, and finally compromised in pursuit of placing DPMs in their rightful place—not based solely on a degree, but on one’s education, training, and experience.

We are entering perhaps the most difficult area of the Vision process, when we start to get what we asked for: 3-year, comprehensive residencies and all graduates with a universally strong level of education, training, and experience. We are preparing this generation of DPMs to pass boards equivalent or comparable to the allopathic or osteopathic boards.

Why is that difficult? Well, soon we have to go for the buy-in of the other medical associations and the state boards of registration as well as the legislatures to change the laws placing us in a position of parity and legal equality with other physician groups. When this comes to fruition, we will hopefully solve the abomination of fee discrimination and economic credentialing based solely upon degree. We must, then, as a profession, take the strategic planning goals and implement them with efficiency and attention to detail. It is incumbent upon all of us in this room to take the messages delivered in this House of Delegates and from APMA and get into the hands of the rank and file members.

Again, let me remind you that leaders. . .provide direction. This leads me to communications enhancement, another area I would like to see us work on this year.

APMA has worked very hard, as have our components, to ramp up our communications to the membership. The recent APMA communications survey will help us to guide the direction of our communications department. This survey will assist the board and the stakeholders in our strategic planning sessions to better plan for a methodology to reach as many members as possible for the least amount of expense. “By giving the people the power to share, we’re making the world more transparent,” said Mark Zuckerberg, founder of Facebook.

I hope and plan to reach out to as many of the component leaderships and their members as I can this year. Of course, I can’t simply come out and read the information to all of the membership, but interaction with the masses is possible via technology. In the interest of economy, I hope to increase the APMA visibility with the use of Skype. Skype is free and quite effective. I will make myself available to Skype for any component’s meeting: regional, local, or perhaps a board meeting on a one-time basis. It will need to be based upon my availability and schedule as all of our schedules are quite demanding. We debuted this idea at the California Podiatric Medical Association retreat (thanks to Dr. Cornelison), as I was unable to attend in person due to Hurricane Earl. It was a great success. This will afford many components the chance to interact with APMA and its president while at the same time saving on time and travel costs.

Leaders. . .lead by example

On to Title XIX and APMAPAC. Despite the extreme efforts of a great many individuals we have yet to achieve our goal of the change in Title XIX. As health-care reform evolves, it is uncertain where Title XIX comes into actual play, but actuarials have noted that health-care reform in its current form will swell the ranks of the Medicaid program into the 65 million-plus subscriber range. There simply is no way we can allow that to occur without podiatric medicine being part of the equation. Frustrating, yes. . ..just ask [Faye] Frankfort [director of Legislative Advocacy] how much so. But, we must stay the course in this battle to be viable in the health-care reform world.

Where does leading by example come in? Well, it starts with dipping into our own pockets year after year supporting the APMAPAC to the best of our ability. Each member of the Board of Trustees is again in the $1,000 club this year. Each of you must also set an example for your constituents by contributing. It is participating in the legislative conference, days on the hill in Washington, and in our Home District Lobbying Event. The legislative conference has changed its look this year. It is critical that all of you and your constituents, the members, register for and participate in the at-home visitations with your representatives. Congress has chosen to go home 1 week each month this session to be with their voters. So, let’s get right in their faces when they are close to home—lead by example—and push our agenda.

Leaders. . .make the expected connections

Making connections with as many of those who affect your profession, career, or family is critical. I can tell you of many examples where making connections enhances our position in life. The connections made in the pursuit of gaining a baseball scholarship for my son (with a little help from his talent); the connections made via a health-care fair, which led me to podiatric medicine; the connections made in podiatry school, which led me to my practice (and to my wife).

We need to further our connections to the other parts of medicine on the issues that we have in common. We must hope that those connections will lead us to solving the issues where we differ. CPMA has been very successful in its model of collaboration with the California Medical Association, Maryland successful in its equal payment act, and New Hampshire with its guild connections. I am here to tell you, though, this does not work everywhere. We have tried and tried in Massachusetts to no avail, yet in reaching the Massachusetts Medical Society, to simply have meaningful discussions. Still, we must continue to reach out for such connections.

A recent meeting with some leaders of the American Osteopathic Association has helped to shed some light on some of the issues we may collaborate on in pursuit of our Vision 2015 goal. We are fortunate to have Dr. Karen Nichols, president of the AOA, addressing our meeting tomorrow. Once again the AOA has agreed to write a letter of support for our Title XIX initiative. This is the result of communication, collaboration, and making connections. We thank the AOA for this letter of support.

Somehow, some way, I would like to get this process going again with AMA. They are a tough crowd, not always so willing to chat about our issues. Why can they not see the forest for the trees? Every issue does not have to be a battle. Let’s talk about issues we can work on together: tort reform, insurance discrimination, out-of-network lawsuits among the most significant. Let us educate the AMA, as to why we too are physicians and lose the ignorant, archaic view of podiatrists as they think we are. Thank you to Dr. Annis from the AMA board of trustees for attending our House of Delegates.

As for collaboration, the Society for Vascular Surgery [SVS] and APMA have developed a collaboration like no other to date. Here is a model that works, AOFAS. We know it can be done.

Our SVS collaboration continues to blossom. The presence of Dr. Zwolak, the president of SVS, here at our meeting is a testament to that. Dr. Caporusso and I were feted like royalty at the annual SVS meeting held in Boston last summer. We were treated as equal colleagues in medicine. We have also been invited back for their summer meeting this year in Chicago. Dr. Zwolak is speaking at a plenary session this summer in Boston, at the Annual Scientific Meeting, and no doubt will be well-received—a prime example of collaboration for the greater good.

I also desire to develop this year an Interprofessional Relations Committee to start to move even further ahead in the collaborative process. I see this committee making connections with the aforementioned entities, as well as others.

If you need reassurance that collaboration is important, look at our corporate sponsor Biomedix, which has an entire book of business dedicated to the collaborative-care model.

Leaders. . .protect their people from danger while exposing them to reality

Oh, that dreaded word, reality. This leads me to the Health Policy and Practice and Center for Professional Advocacy [CPA] departments, the areas where I am most comfortable.

The big topics on the agenda this year are the beginning of the conversion to ICD 10 and the uptick of activities in the CPA. ICD 10 will be one of the most monumental changes to our practices in our careers. We will be moving from a universal coding system of five digits to one of an alphanumeric system with seven characters and seven times the codes! These codes are fluid and will potentially change with every encounter. This paradigm shift will begin formally in 2013, but we have to get ready now. It will not be delayed. It is coming.

The coding committee has a very ambitious agenda set out for the next 2 years to prepare and educate the membership about the conversion to ICD 10. Local, regional, and even national fora are planned. This member benefit is one not to be taken lightly. This will include the crosswalk of the ICD 9 system to the ICD 10 system on our Coding Resource Center; a most valuable investment to consider.

HIPAA and the electronic changes are already in place. APMA already has the recent HIPAA updates and electronic requirements on its Web site. It is of paramount importance that the members are made aware of this resource and take full advantage of it.

A leader protects from danger. For our community, this comes in the area of education and fraud protection. We are fortunate to have a medical malpractice carrier such as PICA that offers us a fraud protection plan. We at APMA and in the Health Policy and Practice department are here to help prevent members from making mistakes that can be misconstrued as fraud. We are constantly reviewing coding and policy changes in an effort to educate the members so they can protect themselves as well. We often have to deliver messages about reimbursement and coding issues to the membership, ones they do not want to hear, but it is our job to be honest, even when the answer is not one we want to hear.

Providers can be most creative when it comes to coding. We do our utmost to offer accurate—although sometimes painful—coding information. The Coding Resource Center is one of the greatest products ever offered by APMA to its members. Our involvement in the CPT and RUC processes allows us real-time involvement in the development of codes and rapid dissemination of information. APMA both protects you and helps with reimbursement. I can assure you that vendors selling coding products do not think that way.

Change can appear to be painful, but it is necessary. “Winners must learn to relish change with the same enthusiasm and energy that we have resisted in the past,” said Tom Peters, a business consultant and lecturer.

I do not expect to change everything in a 1-year term as president. I do expect though to be forward-thinking in preparation for change. Not unlike Vision 2015, we must look forward and be prepared, be proactive with foresight and without fear.

The Center for Professional Advocacy is one of the landmark changes APMA has made in its pursuit of member protection via legal representation and information gathering. The CPA, first thought of to be a litigation center, is so much more. Thanks to a resolution from this House, the CPA is now up and functioning, changing from the somewhat subjective delegation of legal and legislative grants to one of process, fairness, cost sharing, and access for all when legal issues arise. I see the CPA really coming to life this year as we see the ugly realities of fraudulent activities by the insurers, fee discrimination, tiering of payments, and scope of practice issues rising before us.

Eventually, there may be a melding of the CPA with State Advocacy and even Health Policy and Practice. Common issues between these departments will require a cooperative effort. An interwoven relationship between these departments is essential to the efficiency and success of each. You all know my disdain for the insurance industry from prior addresses. It is time we use the processes available to stop their cheating us of our abilities to earn a fair and equal fee.

I have been directly involved with the two class action lawsuits APMA has had with the insurers and was the deponent for the most recent and still active suit over their fraudulent manipulation of the UCR [unified carrier registration] scales and payments. The CPA is our vehicle to combat these titans of legal mischief when we see the need arise. The CPA is modeled such that every member and every component has access to this vehicle and can be actively involved in the process from the outset.

Leaders. . .don’t blame, they learn

“Fix the problem, don’t fix the blame,” said Rev. Robert Schuller—one of my favorite expressions. I use this expression daily in my practice when that patient. . .you know who they are. . .comes in railing about what caused their problem, or who didn’t fix it for them. This is a mantra we all need to adopt. We are a family and need to return to the days of total unity. We are a team. We have common goals. No one person or group can solve all of the problems we encounter, but by sharing of information and helping each other, not pointing fingers, we can solve the vast majority of the issues we face. Let’s all move forward and fix the problems—not the blame. Let’s learn from each other’s mistakes and successes, share those lessons, and advance this wonderful profession of ours.

I am currently in the process of developing a Presidential Advisory Council. This council will be made up of unique individuals with unique talents and a finger on the pulse of the profession. I have selected a small but select group of individuals who may not get much visibility but have a keen idea as to what the general membership is thinking. One of my loftier goals is to move toward a version of leadership council calls. These will be perhaps two or three in number and will involve the chairs of each committee of APMA reporting to each other and me a brief, concise update on what they are doing and achieving in their leadership roles. This is modeled after the successful senior staff meetings held at the APMA headquarters by Glenn [Gastwirth, DPM, executive director and CEO] and Jay [Levrio, PhD, deputy executive director] and their directors.

Finally, the job of the leader: make new leaders!

This gets me to the area of the students and the young members. We now have some of the best and brightest young men and women entering our profession, thanks in large part to our Marketing and Career Development department. As the quality of medical education has improved, so has the quality of the student. That should be expected to lead to a better practitioner. Those of us in leadership need to embrace the young members and the students—hopefully future members of this profession—and mentor them to become leaders. No, not everyone is destined or cut out to be a leader, but we need to seek out and nurture those who are.

The only way this profession is going to grow stronger is by us imparting our wisdom to those junior statesmen. We need to start with mentoring at the high school and college level, finding the best and brightest for our schools. We need the schools of podiatric medicine to play a key role in the search for and development of those students. We need to mentor those that choose to lead to become better leaders. We need to again find ways to fix problems, not blame. We must assure those young people entering the schools that they will be afforded the privilege of a 3-year comprehensive residency program upon graduation.

I challenge you, the leaders of this profession, to continue to find and build programs for these graduates. I challenge the schools of podiatric medicine to take a more proactive role in finding and developing these programs for those students you have selected to matriculate.

APMA is acutely aware of the problem of residency need and genesis. We are in constant discussion with all stakeholders at any and all levels. The CPME has done a great job this year in working to solve this dilemma. Thank you.

We are not alone. Allopathic and osteopathic medicine face similar issues. We are in a somewhat better position in that our programs are not capped in the GME [graduate medical education] funding scheme. Our problem lies in resources, and in the startup funding hospitals need to start such programs.

I challenge the students and the young members as well. Do not let us down. In our strategic planning, I would like to discuss the prospect of holding a Young Members/Resident Expo. This could begin with regional presentations of 1 to 2 days in length for residents and young members up to 7 years in practice. This exposition would hopefully be funded by industry. Topics such as banking, health-care law, practice design, and partnerships could be addressed. We can further demonstrate the benefits of APMA membership and proper use of existing APMA resources. They are our future.

The most important thing for a young adult is to establish credit—a reputation and character. You will be representing all of podiatric medicine. I hear rumblings among our students of some being challenged by interviewers and potential employers as to with whom their loyalties may lie: with APMA or with other podiatric entities. Such questioning has no place in this small profession and only leads to fear and divisiveness. When necessary, ethics charges will be levied. Ethical breaches will not be tolerated among the members of this profession, especially when directed at students or young members.

And now for the thanks

My family: I saved this for last as I get emotional when it comes to my family and the loyalty of friends. I cannot describe how blessed I am with family. There are a lot of days on the road when one chooses to follow this path of leadership. It is a labor of love but laborious nevertheless.

My wife Laura, the love of my life, I cannot thank enough. She has allowed me to pursue my career and this second career while raising our children superbly. She is the glue that holds this family together and keeps us strong with love.

My children, Lindsay and Christopher, the reasons I live and breathe. We have been blessed with bright, articulate, loving, and successful children. They have been patient while Dad is away but never waiver in their support. I love you both so much.

My dad would have been so proud today, God rest his soul. He would have been bursting his buttons today. Thanks, Dad.

My mom is recuperating from recent surgery and couldn’t attend today either, but she is here with me in spirit. I was blessed with two incredible and loving parents. Thanks, Mom.

I am also blessed with in-laws who are essentially my second set of parents, and I see them in the same way I do my mom and dad. Thanks, John and Rita.

To the rest of my family and friends. . .my love and thanks. My brother Jeff and his family, my in-law family, thanks for your support and for being here with me today.

To my staff, two of whom have been with me for over 20 years. Fatima and Maria and Sue. These guys have put up with more rescheduling than one should endure in a lifetime due to my relentless days of travel and phone conferences. Thank you.

To my partner, Tony and his family. Thanks for picking up for me on all those weekends I have been away and providing great care to our patients. Also to Rich Eisner, for his support every Friday in the office.

To my fellow board members, to APMA staff, and to you, the House of Delegates. Thank you for trusting in me to be your leader for this next year. I am eternally grateful.

Back to mentoring for a moment. My mentors have been numerous. I have pointed out few, as there are far too many to mention, and I don’t want to leave anyone out. Of course, my closest mentor and great friend, Dr. Lloyd Smith. . .what more can I say?

I do, however, have a couple here today. My high school football coach and his wife, my English teacher: Coach David Slosser and Ms. Dee Slosser. Coach, your early guidance and support to a young high school athlete has never been forgotten. I am thrilled that you both chose to be here today. Thank you!

Henry Green, DPM, my earliest political mentor, residency teacher and friend. Dr. Green instilled in me very early on the importance of belonging and being involved politically. Giving back, coming back to your roots, and thanking those that helped you along the way by leading others to lead. Thank you Hef!

Conclusion

Ladies and Gentlemen, we have come a long way since I entered this profession 30 years ago. We have much work still to do, and we need all of us working toward our goals: parity, the end of fee discrimination, the universal recognition of the DPM as physician, and our rightful place as the absolute guardians of lower extremity health in this country.

I thank you for the opportunity to serve as your president. I welcome the challenge.

As motivational speaker Og Mandingo said, “I will strain my potential until it cries for mercy.”

Thank you.