Acceptance Address APMA House of Delegates Washington, DC March 25, 2002

President Sowell, Board of Trustees, Speaker Munsey, delegates, alternates, and guests:

I am deeply humbled and honored to be elected as president of the American Podiatric Medical Association. I pledge that I will do my best to maintain the high level of professional effectiveness that characterized my predecessors. I know that APMA—a well-oiled machine—will continue to function effectively, as it has in the past. Thank you for providing a dedicated, competent, and motivated Board of Trustees. I especially want to thank President Sowell for his hard work, high level of integrity, self-sacrifice, and keen intellect, which have helped APMA for so many years. Doug and Linda, thank you very much.

My thanks also go to Dr. Glenn Gastwirth, our executive director, and the entire staff of APMA for the extraordinary professional manner in which they assist this Board and our profession in continuing the superior performance of APMA.

Like those of you seated in this room, I have enjoyed many years of organized podiatric medicine. Each of us knows what it is like to miss countless family gatherings, birthdays, baseball games, formal dances, football games, Boy Scout camp-outs, soccer games, and sailboat races. To your families and to my wife, Meg, and my children, Anne, Tom, and Andy, and their spouses and children, I say “thank you” for letting us go. Thank you for allowing us to meet our professional goals and to give back to this profession that means so much to us.

The state of the association has changed dramatically since the early days of organized podiatric medicine. In the Lisabeth M. Holloway text, A Fast Pace Forward: Chronicles of American Podiatry, there is a description of the first meeting of organized podiatric medicine in the United States of America. That meeting of the Pedic Society, on June 3, 1895, was a pretty stormy affair. The World, a local New York newspaper, reported that a band of intruders—including “girls of 20 and silvery-haired old men”—gathered at 35th and Broadway and, on the stroke of 2:00 pm, burst pell-mell into the “perfumed and beautifully appointed offices” of H. Howard Levy, chiropodist, where they interrupted “about an equal number of men and women” who had met to organize the society.

Our meeting today is in stark contrast to the humble beginning 107 years ago.

That first meeting was specifically authorized by New York State Senate Bill 195, urged through the legislature by Senator [Baxter T.] Smelzer “in spite of the ridicule heaped upon him.” The bill had been signed (only an hour before, said The World) by Governor [Levi P.] Morton, who was sympathetic to the cause by reason of personal experience: He had had foot surgery some time before. Under the new law—the first licensure law of the American profession—chiropodists would have to pass state examinations and be licensed to practice.

What a coincidence; after the Medicare law was passed, it was only because of the personal experience and insistence of President Lyndon Johnson and his wife, Lady Bird, that podiatric medicine was added to the law.

Our national organization held its first official meeting in Chicago on July 1, 1912. There were 225 practitioners present, a constitution was drafted, and the committee process began. There were very few podiatrists, and they had a limited education, a limited scope of practice, and very limited governmental regulations. But they recognized the importance of providing appropriate foot care.

Today we face a different situation: More than 12,000 podiatric physicians have a world-class education, enjoy a greatly expanded scope of practice, and labor under extensive government regulations.

We have arrived! 

Organized podiatric medicine has arrived as the recognized medical and surgical specialty dealing with the foot and ankle.

We have arrived! 

Why do I make this curious statement? Medicare has told us that the majority of the surgical procedures billed for the foot and ankle come from podiatric physicians. A recent public opinion poll asked the question, “Whom would you seek for a foot and ankle problem?” The repeated and overwhelming answer was “a podiatric physician.” This survey was not conducted by APMA. The public clearly has decided that they should see a DPM for a foot or ankle problem.

We have arrived! 

The United States government, through the services of HCFA, or Medicare, now known as CMS, the Centers for Medicare and Medicaid Services, routinely contacts APMA regarding questions about foot and ankle care. Our Health Policy Committee continues to visit CMS headquarters to enlighten Uncle Sam on matters regarding the care of the foot and ankle. APMA is invited—and is pleased—to explain what benefits and level of care should be provided in this country. The federal government recognizes that the APMA membership has the unique authority and sophistication in medical and surgical skills to provide improved comfort, better function, and reduced amputations.

We have arrived! 

Private insurance companies have reported that podiatric physicians perform the majority of foot and ankle care in this country. Many DPMs have served as consultants to private insurance companies to offer expert opinions on technical questions about appropriate foot and ankle care. Our Health Systems Committee has created an atmosphere in which managed care and insurance companies know that APMA will be relentless in pursuing the satisfaction of the need for complete and appropriate foot and ankle care for the insured public.

We have arrived! 

The Joint Commission on Accreditation of Health Care Organizations has granted our profession an ongoing position on the Professional Technical Advisory Committee to answer questions and provide our technical expertise on issues relating to care of the foot and ankle. Our surgical affiliate, the American College of Foot and Ankle Surgeons, has helped APMA in providing testimony supporting the performance of independent podiatric histories and physicals. No competing specialty has this unique recognition at the Joint Commission.

We have arrived! 

The organizations that update diagnostic and procedural codes for federal programs such as Medicare have invited our profession to testify on new or revised procedure and diagnostic codes. These groups are the RUC and CPT committees of the American Medical Association, which recognize the importance of podiatric medicine. We have no peer in this arena. We provide testimony on appropriate values for office visits, ankle surgery, reconstructive foot surgery, new technologies of medical foot care, and hospital and nursing home visits. You are able to use these new codes today because APMA has presented credible information. Furthermore, the information provided by APMA has returned many millions of dollars to members of APMA. The increase in Medicare payments to podiatric physicians has been $156 million in the past four years.

We have arrived! 

There has been a series of studies conducted by the profession to determine how podiatric medicine can be improved. The Selden Commission report of 1960 had many goals for podiatric medical education, including a widely accepted definition of the profession, a change in status so that each college should become a division of a nonprofit institution, a list of responsibilities of the Board of Trustees of each college of podiatric medicine, a change so that each college would own and operate its own clinic, and a new requirement in each college for adequate laboratories, live-animal housing, research facilities, faculty office space, and audiovisual equipment, as well as for full-time PhDs in basic sciences, along with other lofty goals. Most of these changes have occurred.

We have arrived! 

Project 2000 has given us guidance, with 19 specific objectives to be completed by the year 2000. Most of these goals have been accomplished. A repeated objective is for our colleges to be integrated with academic health centers. It is difficult for independent podiatric medical colleges to prosper. We may now look at our colleges that have achieved these affiliations: The Pennsylvania College of Podiatric Medicine is now Temple University School of Podiatric Medicine, and the Iowa College of Podiatric Medicine is part of the University of Osteopathic Medicine and Health Sciences in Des Moines. The recent affiliation of the Dr. William M. Scholl College of Podiatric Medicine with Finch University is another accomplishment. The California College will be located at an academic health center in the East San Francisco Bay. Our college in Florida functions in the Barry University School of Graduate Medical Sciences.

We have arrived! 

The fifth objective of Project 2000 was for each graduate to have a podiatric residency. As we know, there now is a surplus of residency positions for our graduates. Objective 10 called for alternative funding for podiatric medical residency programs. GME funding is now available across the country. Objective 11 boldly stated that the Council on Podiatric Medical Education should consider developing criteria and standards for subspecialty fellowships. This has been done. Objective 13 called for the CPME to be autonomous in the accreditation process. That has been done. Objective 14 called for a mechanism for the generation and funding of research projects within the profession. Our Podiatric Research Advisory Committee (PRAC) has funded many projects and continues to evaluate research projects. Another objective of Project 2000 was the establishment of a Department of Education in APMA. That has been done. APMA’s Education Committee has assumed this responsibility.

We have arrived! 

A sign of strength in an organization is the percentage of professionals who participate in it. While other large medical associations struggle to maintain 30-percent membership, more than 75 percent of our practitioners are members of this association, and the percentage is growing.

We have arrived! 

Private insurance companies have consultants to assist with specialty care questions. The Medicare system of using private insurance companies is the manner in which federal Medicare, Railroad Medicare, and Medicaid are conducted. Nearly every federally contracting insurance company has a podiatry consultant. Many of these experts meet on our APMA Carrier Advisory Committee. Generally, the procedures established by Medicare become adopted by the private insurance industry, PPOs, and HMOs.

We have arrived! 

Podiatric medicine has arrived with a very strong presence on the Web. In the January 2002 issue of the AARP magazine Modern Maturity, the 10 best health Web sites were named, and APMA’s public Web site was one of them. The article stated that more than 100 million people have visited online medical sites. It also states, “Here you can read all you need to know about foot health and also locate a podiatrist in your area.” The user-friendly nature of our Web site, its vast amount of information, and the frequent updates have greatly increased the public’s knowledge of the importance of foot care by doctors of podiatric medicine. Our member locator site is extremely helpful to the public and is widely used. My thanks to all at APMA who have worked on our Internet presence.

Two years ago, Dr. Lepow stated that APMA should provide continuing medical education to our members on the Internet. This is now a reality.

We have arrived! 

When I began serving on the APMA Board about ten years ago, Dr. Paul Selander, of Arizona, was president of APMA. He proposed that we establish multiple endowment programs. Funds would be set aside automatically every year to endow several of APMA’s functions. Our Board of Trustees initiated a long-term plan to endow our research program. Our legislative assistance grant program and our legal assistance grant programs are on the endowed track. I am very happy to tell you that in the past ten years we have almost fully endowed our research program, with a final goal of more than a million dollars. The other programs will be fully funded for the future in only a few more years.

I served as the chairman of PRAC for several years. APMA’s research program, approved by the House of Delegates, has funded many research studies. Dozens of significant research projects would not have been completed without this use of our dues income. In the near future, the funds will be available to let the program continue without requiring dues funds.

The same will soon happen with the other endowed grant programs. APMA was able to look into the future, anticipate a need, and provide a permanent solution.

The APMA financial reserves are the highest in history, with recent surplus contributions by the Board of Trustees. We have prioritized our goals and the use of our resources. The Board of Trustees has demonstrated fiscal accountability to this House. The fiscal planning of this organization has allowed us to become a stable and strong organization, and that bodes very well for facing future challenges.

We have arrived! 

Now that we have arrived at this plateau, where are we headed for next? The team I have put together has much work to accomplish in the coming year. Each member of the Board of Trustees has multiple committee assignments and liaison activities. I have made more than 200 appointments. It would be time consuming to mention each Board member and his or her assignments, but they are extensive. My thanks to each of my colleagues on the Board and all of the committee members for their hard work and dedicated service.

Because we have arrived at this advanced state of accomplishment, I assure you that APMA will not become complacent. We have new horizons to conquer. I hope that this year we will make progress with federal legislation or regulatory change that will allow the Conditions of Participation of Medicare to be corrected. This will allow podiatric physicians to continue to perform independent histories and physicals for all of their patients.

Why should a podiatric physician be required to obtain a second history and physical at 2:00 am before taking an emergency patient to the operating room? Changing this situation is a priority. Another priority is to continue to ensure that the patients of this country receive the full benefits of podiatric medical care under Medicare and Medicaid. The at-risk foot deserves APMA’s full intervention to provide optimal podiatric medical care.

I will encourage the continued funding of APMA research projects, the restoration of denied benefits by private insurance companies, major efforts to assist our colleges in student recruitment, equal pay for equal work, the expansion of our member and public Internet Web sites, and assistance to components with scope-of-practice issues. Our Diabetes Advisory Committee will continue to oversee our profession’s activities in the care of the diabetic foot. We need to be certain that we have sufficient graduates from our colleges to ensure that we are a viable profession with a critical mass. I believe there is a future risk of having insufficient podiatric physicians for an aging population with an increasing incidence of diabetes and expanded benefits for foot care.

The Board of Trustees, APMA committees, and this House of Delegates will continue to manage the affairs of our association so that the people of this country receive the highest and best type of foot and ankle care available. Your Board will be tireless in dealing with all issues affecting podiatric medicine. We will travel to any meeting, confer with any government group or individual, talk to any insurance organization, deal with any legislation, promote the research and science of podiatric medicine, and assist the colleges of podiatric medicine. APMA is ready for the challenge.

Thank you for your attention.