PRESENT's CEO, Alan Sherman, DPM
Interviewed on the Dr Tyson E. Franklin Podcast: Now Hear the Rest of the PRESENT Story

International podcaster Tyson E Franklin and Alan Sherman, DPM spent a very pleasant session recounting the story behind the development of Podiatry Online and PRESENT e-Learning Systems and the part that it has played in the ongoing advancement of the field of podiatry. After a review of how this all came to pass, Dr Sherman delves deeply into the current state of podiatry in the US and the place that education plays in its ongoing advancement.

21st century online education came early to podiatry, when PRESENT e-Learning Systems first put lectures online for podiatric residents at PRESENT Podiatry in 2003. Two years later, they introduced the first online CME education program for podiatrists with full video lectures and in two more years in 2007, they ran their first live CME conference. In those 16 years and 50+ live conferences later, they’ve built out an advanced online service to deliver reliable, high quality accredited education to podiatrists, from residency to retirement that runs on smart phones, tablets, laptops and PCs wherever you are.

In this blog, Dr Sherman discusses:

  • His first computer purchase in 1982
  • Getting into publishing in 1995 with Podiatry Online
  • Moving away from practice management and focusing on medical education
  • Weekly NewsFlash
  • Starting their own conferences in 2007
  • Why it's important to attend conferences both in and outside of podiatry
  • Looking for trends
  • Narrowcasting (Bill Gates), publish to small interest groups (3000 versus 300,000)
  • Creating a niche and finding a niche
  • Practice Management and Biomechanics two most popular subjects

View the entire interview transcript below or a PDF version HERE.

Podiatry Legends Interview – Tyson Franklin Pocast

 

Tyson Franklin: Hi, I’m Tyson Franklin, and welcome to this week’s episode of the Podiatry Legends Podcast. With me today is another legend from the United States. He is based in Florida. He’s been around for a number of years and his name is Dr. Alan Sherman.

 

So, Alan, how are you doing today?

 

Alan Sherman: I’m doing well. How are you, Tyson?

 

Tyson Franklin: I’m fantastic. I’m looking forward to this. We spoke for a little bit before I pressed record and it was – I was getting all these flashbacks of when I first got introduced to computers and you kicked off. Now, your – business that you run is PRESENT e-Learning Systems. But prior to that, you were doing Podiatry Online way back in 1995, which seems a long time ago for people to be using computers.

 

Alan Sherman: So I had been using computers for 14 years by 1995 because I practiced in Boca Raton, Florida which was the town where IBM had its headquarters for designing and manufacturing the original PC. So for years, I had these young eager engineers from IBM coming in as patients, telling me about this marvelous machine that they were working on and it was going to change everything once they had it ready.

 

And so, I got my first PC in 1982 and had a group of my physician friends that – we were all hobbyists. We would take a particular part and put them back together. We bought a scanner. We started doing photography on the machines and that was back when it was either a green or an amber light on a black screen, and then there was a 16-color screen, and then there was software interpolation that made the pictures more photo-realistic and all of a sudden, we had a photo darkroom with a computer.

 

And so, we enjoyed being hobbyists for those 14 years. And then the miracle happened that the Internet was introduced in 1995 and Marc Andreessen, the genius engineer from University of Chicago had the foresight to release the Mosaic web browser to everyone for free and all of a sudden, it was off to the races, and that’s how I got started with this.

 

I think fundamentally, many doctors are kind of, you know, computer nerds, computer dudes, or geeks in general, you know, where we like science, we like learning, we’re curious. And the computers were just a delight for me and kept me very interested through those 14 years even before the Internet.

 

Tyson Franklin: Well, my first introduction to computers was probably around the same time, but I was still in high school then and we used the punch cards where we had to type different punch cards and then it was 0, 0, 1, 1. And based on your punch cards, you put that into the computer, into the big mainframe because we really just had a huge mainframe with an air-conditioned room that was probably like super cold so it wouldn’t overheat and we all had monitors. We put these punch cards in those and everything. I don’t know if these things were going to take off or not. So –

 

Alan Sherman: I had similar experience. So I did my undergraduate at Colgate University and they were one of the first schools, well, along with the – thinking of – Dartmouth had a requirement to take a computer course.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And we did the same thing. We had punch cards and there was a mainframe. And then they got a hard drive that looked like a washing machine where they would mount platters in it and they would have to do all those calibrations and then start using it. So I learned ALGOL and Fortran programming just a little bit when I was in school because I was required to.

 

Tyson Franklin: Yeah, I – so I remember the early days doing all of that and I was like, “No. I’m not really going to touch these computer things.” I don’t think they were going to last. I haven’t got a spare bedroom to put this mainframe anyway, so – but it wasn’t until probably 1992. Maybe 1992 to 1995 when I got my first computer. And I was telling you before where I had to toss out between the 10-megabyte hard drive and the 20-megabyte hard drive and the sales person said, “You will never, in your lifetime, fill the 10-megabyte hard drive.” So that’s the one that I got and I had to pay $3,500 for it. So a lot has changed. But in 1995, you were kicking off Podiatry Online. So this was when the Internet started for podiatry.

 

Alan Sherman: Yeah. So I was one of those million people that downloaded the Mosaic web browser in the first few days and started exploring the “world wide web” and there were very few websites at that time. And after exploring a little bit, I had the realization that this is going to be a very useful tool for a field that I really wanted to get into and that was publishing.

 

And at the time, there was Barry Block who was doing Podiatry Management and the other was Judith Rubinstein who was doing Podiatry Today and I admired these people enormously and I knew all podiatrists were benefiting so much by the work that they were doing and I realized that I could get into publishing without printing, without having the big initial capital expense and I could sort of ease my way into it and try things.

 

So I set up my first website, the Podiatry Online, in 1995. I used a local company to do my hosting where I can actually go to their plant that’s near my home that I’m talking to you from, and go into the room and see the computer that I was sharing space on which was in a – really in the size of a bedroom closet, you know. I think it was about 10 by 10 or 10 by 12. And yes, they had – they brought all these extra air conditioners in there in order to keep the room cold and that’s where the original Podiatry Online was hosted.

 

And how did I learn how to create a website? I learned on the Internet because the internet was starting to be the greatest way to learn a new field. I – at the time, I was comparing it to a library which, of course, it’s become much more than, but it was at least a library. And, you know, so if I wanted to know something new at the time, I would go to a library and take books off the shelf and work with the researcher. It became so much easier. So what did I learn? I learned website programming and the first Podiatry Online was a very rough rudimentary website, but it allowed me to start putting up on that website, information that was of value to podiatrists and I started out with an advice on how to run their practice, and how to treat patients effectively. So it was medical treatment and it was a practice management and I started by taking the patient information brochures that I had written for my practice, the forms that I used to move patients through the practice, and putting them online and allowing podiatrists to download them and use them.

 

Tyson Franklin: How did you let podiatrists know that this information was available way back then before anyone was doing all these like modern tactics that they use today?

 

Alan Sherman: They found me. I didn’t have to let them know, was the real answer. So gradually, as podiatrist got on the Internet – and who was it at first? It was the hobbyists and it was the people like me who got on the Internet and when a podiatrist gets on the Internet, maybe the second or third thing that they look for, is podiatry. They do a search, and back then, there were – that was before Google, so there were other search engines like AltaVista and Lycos.

 

Tyson Franklin: I remember that.

 

Alan Sherman: And some other ones that I’m forgetting their names now but when you – when they put the word podiatry in there, they would find Podiatry Online because, honestly, there was very little else at that time. So when they came to podiatryonline, the first thing I asked them was, “Would you like to receive our newsletter?” And they would fill out a simple form with their email address and that became our first mailing list and I started sending the podiatryonline newsflash, out.

 

At first, it was once every couple of weeks and then it was once every week and that’s back when we had like 50 followers and then there were – and then there were a few hundred and then there were 500 and then I got it out about once a week. And the newsletter was – it started out as things that I wrote and advice that I gave to the podiatrists and gradually, they started sending in questions and I did my best to answer the questions. And I tried to answer them quickly so that – because they were very often clinical questions. “I have a patient who came in with this and this and what do you recommend?” Or “I just did this and I need to send a claim into an insurance company, how do you recommend that I describe this or code this?” or “I’m having difficulty keeping staff, what do you recommend?”

 

So I would give them an answer and the greatest thing that happened is, gradually, and I was up to about 1,000 members at this point, they started becoming dissatisfied with my answers. So they would say, “No, don’t do this, do this or this is what I’ve done for years.” And it was kind of a sharing and kind of a – maybe like a little competitive, but gradually, they started answering their own questions. Someone would send in a question and I would publish the question and I would give an answer and someone else would send in another answer. And gradually, I was able to step back and become the curator or the editor for this rather than the sole writer. And so by that time, this was towards 1998, 1999. In 2000, we had 8,000 member, 8,000 subscribers.

 

Tyson Franklin: Majority from North America or were you starting to get some from overseas as well?

 

Alan Sherman: I always had a small percentage from outside the US, currently, it’s about 10%. I think it was a little bit less at that time.

 

Tyson Franklin: Yeah.

 

Alan Sherman: But it was about two-thirds of the podiatrists in the US. We had about 12,000 podiatrist at that time. And by the year 2000, I was publishing every day because the volume was such – that if I didn’t, I would get behind. I was getting about 150 letters to the editor every month at that time. So I was busy doing this and my family wasn’t seeing me very much.

 

Tyson Franklin: I was about to say, how did you fit that in with running a practice and having a life at the same time?

 

Alan Sherman: I did it almost all in the evenings– I really enjoyed it and it was exciting that I was sort of hosting this discussion. And so my family was seeing the back of my head a lot, facing the screen and they didn’t get it. And I, at that time, just was excited by the forum. I didn’t see it really so much as a commercial thing. It was a project in community building via electronic publishing.

 

Tyson Franklin: Yeah.

 

Alan Sherman: But I was starting to see the potential there because I saw other people in other industries starting to make a business out of their websites. And then about that time, a good friend of mine, by the name of Michael Schore, DPM started asking me about it. He was one of the subscribers and he wanted to make it into a business. Michael was always very entrepreneurial and had quite a few talents that I didn’t have, chief among them being a great salesperson or a great people person. He just loves to talk to people and he started selling – or trying to sell banner advertising. And companies like IBM and Lucent and AT&T were selling banner advertising at the time, some high-tech companies. But in podiatry, it was very new. When he went to the potential advertisers, they didn’t quite get it yet, so he was not having a whole lot of success but did have enough little success to keep working at it.

 

And then I got a phone call that literally changed my life. I got a call from a woman named Linda Autore who was the CEO of the largest supplier to podiatrists at that time, a company called Moore Medical which is still in business today.

 

And Linda, just joined Moore Medical from coincidentally, IBM, and she was working in Boca Raton, Florida and so, Moore Medical recruited her because she was working in the e-commerce space for IBM and they wanted to e-enable their sales channel. This was a company that would send out a catalog once a month and that’s how they supplied podiatry offices. I ordered most of the stuff from my office from them. You’d call them or send a fax in to place an order. And that was basically it but they wanted to e-enable, so Linda told me that she was going to be in Florida next week and she would like to meet me. She had been told about me and the mailing list and the publication via a friend – by the name of Henry Stark, DPM who practiced in Jupiter, Florida. Henry was a long time customer of Moore Medical, a friend of mine and he said to Linda, “Well, you should talk to Alan, he’s got a big mailing list of podiatrists.”

 

So, Linda came down from the Moore Medical headquarters in New Britain, CT, to meet with me and said, right off the bat, we want to buy you. And I didn’t know the first thing about selling a company. I’d never sold a company. I told Michael, Michael got all excited and right away Linda hired a colleague from IBM, a private consultant who sort of helped her in vetting us. So, they asked for a lot reporting. They want to know everything about it. I provided all the information to them.

 

And Michael started talking to his cousin, Vic Weinstein, MD who was an Emergency Room physician, one of the founders of the American Board of Emergency Medicine, and an incredibly successful businessman and he became our adviser in the sale of the Podiatry Online company to Moore Medical. And he was a great advisor and generally was the smartest person in the room even when the Moore Medical people were there and he introduced us to a very talented attorney and merger expert, and anyhow, we sold the company in 2000 and then Moore Medical employed us for a couple years to run it.

 

It was a life changing thing, both the experience of selling a company and also the fact that they poured a lot of money into it, they completely redesigned the website which was really very rough at the time. And they made it look nice and they made it function nice and so, that was between 2000 and 2002 when we were working for them. I was – I would still run my practice for five more years but more and more I was kind of stealing time from the patient care to run Podiatry Online.

 

And then something interesting started happening. We had gotten a portion of this – of the price for the company, in stock. And the stock was the very – it wasn’t actively traded. It was traded in the American Stock Exchange. We got it at seven, it went down to below two. We figured we would never – it would never be worth anything and it was typical of companies that sold Internet companies at that time.

 

But then the stock started going up. So, the stock went to four, the stock went to six, the stock went to eight, and it was finally higher than what we got it at. And we started making inquiries about it and it turned out that Moore Medical had gotten an offer to buy them from McKesson.

 

Tyson Franklin: Yeah.

 

Alan Sherman: Another company made a competing offer. The stock went to 11, the stock went to 12. We ended up selling all of our stock and they ended up selling the company to Mckesson. So Moore Medical was a $120 million company at that time. Mckesson was a $3-billion-dollar company.

 

Tyson Franklin: A big difference.

 

Alan Sherman: Big difference.

 

And they were on an acquisition rage at the time.

 

Tyson Franklin: What did the share price got up to, out of curiosity?

 

Alan Sherman: It peaked at 12.

 

Tyson Franklin: Okay.

 

Alan Sherman: We might have been able to sell some at 13 or 14 but it was so momentary that we couldn’t.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And then – and then it sold at 12. Linda made a lot of money. The CEO, they – Mckesson immediately fired her. Fired the entire executive staff and put their own people in but kept the name and fired us. So, in 2002 I had one year left on a restricted company, I could not do anything else in that space and went back to running my practice. And Michael and I were –

 

Tyson Franklin: Did they give a reason why they gave, yeah, they bought something that has been working well, that has had a great connection with podiatrists, and then they’ve taken it over, and then they’ve given everyone the boot?

 

Alan Sherman: The answer to that would take up the rest of this interview.

 

Tyson Franklin: Yeah.

 

Alan Sherman: But I’ll tell you a brief answer. We were going up to New Britain, Connecticut every six months and each time, we presented to their sales team, giving them marketing plans for how to use the Internet and Podiatry Online to improve their marketing.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And this was over the course of two years, and they never even did a single thing that we recommended. We were frustrated because we wanted to see this be a success for us and them, and it turned out that they were using those marketing plans to set – to shop Moore Medical out for acquisition and it was successful. They ended up selling the company and Mckesson took it over and they already had an E-channel but it wasn’t doing much but Mckesson made it into what every company eventually did which was another way of selling the products. So, yes, it was – we found it very strange and we didn’t find this out until Linda disclosed this to us after the sale went through.

 

Tyson Franklin: Okay. So, after them taking it over and they gave you the boot, you still had to wait a year before you could do anything else in that space if you wanted to?

 

Alan Sherman: Correct.

 

Tyson Franklin: So, you went back – you went back to working as a podiatrist?

 

Alan Sherman: And I never stopped. But in 2002, I went back to it full time. That’s all I was doing.

 

Tyson Franklin: Yeah.

 

Alan Sherman: But Michael and I started thinking about what else was needed in podiatry. And among the people that we spoke to were residency directors. And the residency directors all told us that they were having difficulty in meeting a certain requirement that they needed to meet in order to keep their programs accredited and in order to keep them funded. They’re funded by CMS, by the government.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And in order for them to keep them funded, they need to be doing an hour of formal teaching each week. And a lot of podiatry residency programs at that time were not in teaching hospitals. They were in small community hospitals and specialty surgery hospitals, and they were finding that to be a bit of a burden. So, they asked us if we could create a PowerPoint Exchange online where they would all contribute their PowerPoint files.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And they’d be able to check them out and use each other’s files. And we thought about it. And this was about in 2003, when high bandwidth internet connections were starting to become available all over the country. And I thought that we could do better than that. That we can actually create multimedia lectures and they would just be able to use the lectures. They wouldn’t have to give the lectures at all. And the original concept was bringing the greatest teachers in podiatry in all the different disciplines, to every residency program, so it would standardize the education. And that’s in fact what we did.

 

I started working on the software to deliver these lectures online. We played with them and it wasn’t all a direct success. We had some failures at first but eventually within six months, we had a curriculum of online multimedia lectures for the residents.

 

We had 52 weeks of lectures that were done by hand selected group of podiatrists.

 

Tyson Franklin: Yeah.

 

Alan Sherman: We were able to hand select the best surgeons, the best dermatologists, the best biomechanics, the orthotist – orthotic specialists.

 

Tyson Franklin: So, you would put these video – these training videos together. So, this is obviously prior to doing webinars as we do today.

 

Alan Sherman: That’s correct. This was when we just put a video file up and people would stream it, would download it.

 

Tyson Franklin: Okay.

 

Alan Sherman: But it wasn’t live. It was – on-demand. So we started approaching the residency programs. Obviously, the initial ones that told us about the education need that they had – they all subscribed that first year. In the first year, 50% of the residency programs in the country subscribed to this with the residents. In the next few, we got to about 75% and we’ve kept about 75% of the residency programs using this product since 2003.

 

Tyson Franklin: Okay.

 

Alan Sherman: So that was our original product and – which still exists today in a, you know, a much more technically advanced form, but that’s how it started. And so, that takes us to 2004, 2005. In 2005 –

 

Tyson Franklin: So if you just get back one step before you go forward was when you had Podiatry Online and you mentioned earlier on it was almost like it was practice management content/medical education.

 

Alan Sherman: Correct.

 

Tyson Franklin: That was the beginning stage. But then, when you moved to the – when you are in 2003, that moved more to a residency program?

 

Alan Sherman: Yes.

 

Tyson Franklin: So you were no longer doing the practice management and – but it was still, the medical side of things because it was part of the residency?

 

Alan Sherman: That’s correct. So this was now PRESENT e-Learning systems and it was all pure medical education, and at first, just for podiatric residents. Yeah.

 

Tyson Franklin: Yeah.

 

Tyson Franklin: So the practice management side, you sort of – did you move away from that because Barry Block was already doing something in that space and you thought, “We’ll just move – stay in the medical side of things”?

 

Alan Sherman: So Barry Block was doing a very good job with that at the time. So really, I started the online discussion among podiatrists and the original email-based publishing format. Barry and I have been friends all this time, and then Barry had been the editor and still is the editor of the magazine, the Podiatry Management Magazine, but he felt compelled to start doing publishing online and I supported that entirely. And very quickly, he took over that niche and has continued to do a great job with it.

 

Tyson Franklin: Yeah.

 

Alan Sherman: So, you know, Podiatry Management is the daily new source for podiatry. I’m a daily reader of that and I’ve actually become the biggest advertiser in Podiatry Management. Yeah.

 

Tyson Franklin: Yeah. I just got mine arrived in the mail the other day. I’ve been getting it now for, geez, it’ll be close to 30 years.

 

Alan Sherman: It’s, you know, it’s a daily read for so many podiatrists and – so Barry really took over that kind of daily news publishing.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And so – but I’ve always done some publishing. So starting in 2003, I started working with a young podiatrist named Jarrod Shapiro, DPM who was a resident at the time. And Jarrod was very ambitious and was an excellent writer and had a writing style that I really enjoyed. So Jarrod started writing for me. Over the years, I’ve employed many podiatrists to do writing, but Jarrod has stood the test of time and is still writing the Practice Perfect Blog that goes out once a week now and does a lot of live and online teaching for us as well.

 

And I do occasional writing now. I’ve continued to do that. But what’s new for us is as – our publishing was always what I call email-centric, meaning it was mostly in email form and we would archive the old editions on the website.

 

Tyson Franklin: Yeah.

 

Alan Sherman: But it really wasn’t a true blog back then. But as of January 1st of this year, I have resurrected the Podiatry Online News Flash and we’re now publishing that as a true blog and we have a group of writers that are writing for that. It’s not a lot of practice management. It’s mostly professional education for podiatrists and help in dealing with the trials and tribulations of being a podiatrist more than really running the practice.

 

Tyson Franklin: You said a lot in this podcast. [Laughs]

 

Alan Sherman: You know, you are front and center in the podcast industry – like I said, you just attended a podcasting conference.

 

Tyson Franklin: Yeah.

 

Alan Sherman: I just think they think it’s a whole world. And honestly, I was – I learned a lot about that world since January 1st. Another thing that I’ve – you know, I set out to teach myself. But we have now installed very capable blog software on the podiatry.com website. It’s integrated into the site. It’s integrated with Facebook, and LinkedIn, and Twitter. And we have a platform that now allows my staff – I’ve got 11 employees, 4 of them work in the publishing, to all collaborate on sending 4-5 blogs out each week..

 

And we’re working on blogs all the time. We use – we developed our own software to stage them, put together the pieces that go together so the images, the teaser, the, you know, I don’t want to get too technical with blogs…

 

Tyson Franklin: Yeah.

 

Alan Sherman: But you’re very familiar with this. And all of that is automated. We’ve got online systems for it and it’s fascinating. I’ve been really enjoying being back in the publishing world like I was during the late 90s.

 

Tyson Franklin: So when you had the residency program in 2003 and then once that was up and running, you were saying in 2005, is this when PRESENT e-Learning kicked off?

 

Alan Sherman: So we stared in 2005. We started making CME accredited education available online. So it wasn’t – what we had before that wasn’t of much interest to practicing podiatrists, it was only for residents.

 

Tyson Franklin: Yeah.

 

Alan Sherman: It was really only residency education community until we got it accredited for CME. So in 2005, we developed software that allowed the podiatrist to purchase lectures online very much like they were purchasing from Amazon and a thousand other eCommerce merchants.

 

And I started following the trends. I started attending a conference called the Alliance for Continuing Medical Education and it – this is the industry association for continuing medical education in the US. I was the podiatrist attending that. Of course, the – they were mostly MD and the people working in the CME industry. And I started learning about delivering education online, the software, the accreditation, the business of that.

 

And – so podiatrists started using that little by little. The trends for getting your CME credit online are sort of interesting. Back in 2005, it was about 10% or 15% of the credit that MDs were getting was online then. From 2005 to today, that’s grown to about 45%.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And it sort of plateaued there. And when we started this online business in the PRESENT e-Learning Systems in 2003, we naively thought that online was eventually going to take over all the CME. It was so convenient, it was so appealing that doctors would stop going to conferences, but of course, we know that that didn’t happen and –

 

Tyson Franklin: It’s probably been the opposite.

 

Alan Sherman: Well, you’re absolutely right. The conference business has never been as large as it is now.

 

Tyson Franklin: Yeah.

 

Alan Sherman: Even when we started doing conferences in 2007, there are – I’m going to say there are at least double the number of podiatry conferences each year now, maybe more. I haven’t really counted, but my sense is that it’s at least double.

 

Tyson Franklin: Do you think that’s the case because it’s one of those things when it comes to conferences, podiatrist understand the value of the face-to-face communication with someone that you can – like you can listen to an online lecture and you can get the information that you require before you continue education, you had to stay registered. But when you go to a conference and you hear someone like yourself get up there and talk or if I’ve gone to an event and have spoken. And people can come up to you afterwards and they can – over a wine, or a beer or a whisky, they can ask you that one-on-one question and get a little bit more personal.

 

Alan Sherman: Absolutely. So I think among the greatest values of going to live conferences is the networking that you do. It’s the talking to the individual or talking in a group that you get so much out of. It’s the peer interaction.

 

We thought we were going to replace that online, so we used to promote – we had a, you know, a blog discussion on the podiatry.com from the start but it was never used that much. We used to promote it as being an online equivalent of live conferences but it never has been. There was tremendous value in attending conferences that online just doesn’t give or the doctors didn’t want to use it in that way, and that’s fine.

 

So – and that’s part of what compelled us to start doing conferences in 2007. We saw that the market for conferences was huge and was under served in podiatry at that time. And we started working with the small group of people that were putting on a conference called Superbones.

 

Tyson Franklin: Yeah.

 

 

Alan Sherman: Richard Reuter, DPM and John Steinberg, DPM and Stan Kalish, DPM, were doing this conference in the Bahamas every year. And we met them at one of the conferences and they were explaining to us how they like doing the educational programming but they didn’t have a website. They are doing the marketing, doing the business operations, booking the venue, all of these was – they didn’t want to be doing that part, they just want to be doing the education. So we had a good back office at the time so we said, “You know, let us try this.” So we tried it for a year, it worked out really well.

 

We liked the business. We were still learning at it at that time. They taught us a lot.

 

Tyson Franklin: Yeah.

 

Alan Sherman: The next year, we bought the company, we bought the Superbones company from them. Then we started a Superbones West in Las Vegas which we’re still running to this day –

 

Tyson Franklin: So they were only on the east coast at that time?

 

Alan Sherman: It was only on the east coast, it was in the Bahamas. And – so our second conference was in Las Vegas, that’s the Superbones West that’s been ongoing since that time. And they continued to work with us and do the educational programming and doing the teaching at the conference where we brought a lot of other people in for teaching after that. And then we met Robert Frykberg, DPM.

 

And Robert Frykberg, DPM was a Harvard-trained podiatrist who was an expert in wound care, a very erudite and didactic person. He’d done a ton of research and was running a small conference for the VA podiatrists every year. And we – he also expressed to us that he needs some help running this conference. So we started running the Desert Foot Conference, we moved it to near where he lives in, in Phoenix, Arizona

 

Tyson Franklin: Yeah.

 

Alan Sherman: And that started in 2008. So we’ve been running Desert Foot since then and that’s become our biggest conference. And we really enjoyed that meeting because of the interaction with all the wound-care experts, and watched it become one of the big wound-care meetings.

 

Tyson Franklin: If people want to know even more about these conferences, just go to your website, http://podiatry.com and just click on the conferences section. And you do about six a year? That’s correct?

 

Alan Sherman: Yes. Easiest way to find everything that we do is at podiatry.com.

 

Tyson Franklin: Okay, podiatry.com. That simple.

 

Alan Sherman: Podiatry.com, it’s a – we try to keep it simple and we acquired that web address many years ago and that’s the easiest way to get to it.

 

And they can – at that address, they can be linked to all the conferences, to all of the online education, to everything that we do.

 

Tyson Franklin: Okay, so it takes you straight to the PRESENT Podiatry page.

 

Alan Sherman: That’s right. And what you’ll notice about the PRESENT Podiatry page is that it’s a blog now. So all of our publishing has been brought to the front page of podiatry.com and you’ll see the latest blog there, which in today’s case is Jarrod’s “Practice Perfect” this week where he wrote about comparing old-fashioned surgical lavage to the new high-pressure pulse lavage. He read the literature on that and reports on the outcomes of using either of those two techniques and compares them.

 

Tyson Franklin: So there’s a ton of information on here if people want to go searching through. There’s a lot that they can go through.

 

Alan Sherman: We get most of our traffic from Google searches. Of course, a lot of people are going directly to the site to watch lectures and get education. But it’s a very current, sophisticated website now that it’s connected to the world of podiatry.

 

Tyson Franklin: So what’s next? What have you got lined up next?

 

Alan Sherman: Well, just to finish the conference story, we had three other conferences after that, that I’m really most proud of. We realized that we were reaching a large group of people working in the residency education community but they didn’t have a conference to go to and we thought they would benefit from just what we spoke about.

 

The benefit of networking with other people in their community would afford them. So, we started the residency education summit conferences.

 

We put on the first Residency Education Summit Midwest in 2011 and then the next years we added one outside of New York to serve the Northeast part of the country. We just did this year’s East Summit a few weeks ago, and we’re doing the Midwest next week. And that’s a conference where we get hundreds of residents, residency directors and practicing podiatrists all getting together to learn together. The practicing podiatrists want to see what the residents are doing now.

 

Tyson Franklin: Yeah.

 

Alan Sherman: We put on social events at those meeting and we run the Residency Rumble which is sort of a high-tech game show. The questions for that are contributed by the American Board of Podiatric Medicine each year. And we have a fun, sort of, competitive kind of tense but fun evening of a competition. I love running that. We just – I think we ran the 16th one, this is going to be the 17th one next week.

 

So, I’m very proud of those meetings for the residents and it goes part and parcel with the online lecture series for them which about 75% of them are using now and I think both of those services together have helped to standardize the education of the residency programs and sort of equalize them to bring the same type of teaching to every residency program whether it’s at a Harvard Teaching Hospital or small community hospital in the mid-west.

 

Tyson Franklin: I think it’s great. So, at this point, we’re recording this now, early September. So, by the time this comes out, your September event will be over, but you still got two events coming up this year in October in Las Vegas and then December in Arizona. And then these three events for 2020 already on your website. So if people need to – if they want to get any more information, just go to podiatry.com which is not going to be hard to remember. Even if you’re driving your car now, you don’t even need to write that one down.

 

So, that’s the easiest way to find out about these events.

 

Alan Sherman: We – so, we’re running six conferences a year and they’re all over the country. And our latest conference, we’re working with the Los Angeles Podiatric Medical Association, which at 600 podiatrists as big as many states, in fact, we figured it was bigger than 2/3 of the states in the country as far as population of podiatrists. So, we run this in February, in downtown LA, it’s called the PRESENT Treasure Hunt and that’s the end of the story as far as the conferences, for us. Its six conferences. We welcome podiatrists from all over the world to attend. Every time we have a conference, about 5% of the attendees are from outside the country.

 

Tyson Franklin: Yeah.

 

Alan Sherman: So we’ve had attendees from Zimbabwe, Nigeria, Australia and United Kingdom. We get many from Canada, of course, because it’s the closest country to us. And we’d like – and we’d like to get more, but, you know, of course it’s a – it’s a big trip.

 

Tyson Franklin: But I think that’s a good thing about even going – to attending conferences overseas. The connections that you make, like, you might see on the back wall here, I’ve got a quote I have up on the wall. And it says, “The next connection or your next connection could be the one that changes your life.”

 

And I think it’s really important for people to want to attend events, whether it’s in your local area or state, national or especially international and just – and especially the earlier in your career you start doing this and making connections with people, you don’t know 10-20 years, 30 years down the track, where those connections are going to lead you. I think it would be just staying in your practice – just hiding away from everyone and not attending events, I don’t think that’s the best thing you do for your career.

 

Alan Sherman: I totally agree with you and share that value. And I also, suggest how valuable it is to attend conferences outside of your core area.

 

Tyson Franklin: Yeah.

 

Alan Sherman: So, I think podiatrists really benefit from attending orthopedic conferences or even general medical conferences just to get the perspective on how they’re teaching and what they’re learning and what they’re interested in. And to see trends because often the trends don’t start in podiatry but they always end up with us. We – and we have lead some areas but we’re also followed in a lot of areas. I think there’s a lot to be gained by diversifying the conferences that you go to.

 

Tyson Franklin: Yeah.

 

Alan Sherman: I would recommend that each year, podiatrists attend at least one conference outside of their core area of expertise.

 

Tyson Franklin: But I remember Dockery talking about plastic surgery, how he used to see plastic surgeons could do some operations and with very minimal scarring. Podiatrists are doing operations with a lot of scarring going, we need to learn how to bring that into the podiatry world. So he had a big interest in that area and then I know other podiatrists had an interest in dermatology. And they went off to a lot of dermatology conferences and they started bringing their information back into podiatry. So, it’s important to look outside of what we’re used to.

 

Alan Sherman: Dock is one of these brilliant creative teachers in podiatry that have brought a lot of expertise to the profession. I mean, I would – I would put a whole group of remarkable men and women in that category. I would put Bryan Markinson, DPM certainly Warren Joseph, DPM, Tracey Vlahovic, DPM in that category. All brilliant podiatrists who obtained advanced training and went on to teach a generation of podiatrists what they learned.

 

I am sure I’m missing a lot of brilliant people that the – many of the ones that I’ve mentioned have gone on to do fellowships in disciplines, in dermatology, in pathology, in surgery, and then they have then shared that knowledge with the podiatry field when they go and teach.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And what – and that has been – that has driven a lot of our growth. Not that we haven’t done incredible innovation in podiatry. I mean, in the field of foot surgery, all orthopedic surgeons that are interested in feet, read the foot literature and regard us as one of them as we regard them as one of us. That’s what’s happened.

 

In 1981 when I did my residency, there was discrimination against podiatrists and we had a fight in United States for, you know, to be treated well and to be respected. That is no longer the case. There is no – I would make the statement now that there is no longer discrimination against podiatrists. There is simply competition.

 

Tyson Franklin: Yeah.

 

Alan Sherman: What we do overlaps with orthopedic surgeons, dermatologists, plastic surgeons, infectious disease consultants, so there’s always turf battles. But I think the discrimination that you and I have had is largely a thing of the past – which is really a wonderful thing to realize and to support.

 

Tyson Franklin: No, I think it’s great. And I like what you’ve shared – I like what you’ve done, you know, just the whole online world with your career from start to – I will not say finish, because you’re not finished yet.

 

Alan Sherman: I’m not.

 

Tyson Franklin: – the earlier question I asked you, what’s next for you? What have you got lined up next? What are you going to blow our minds with?

 

Alan Sherman: Gee, that’s a tough question. I mean it’s a daily pursuit to keep up with the standards of publishing on the Internet –

 

Tyson Franklin: Yeah.

 

Alan Sherman: – and standards in education. So we intend to continue to keep up with those standards and do as well as we can in those areas. I’m not sure if this is really what you were looking for in that question, but, we have an annual subscription to our lectures online now, which is our biggest product online.

 

We’re planning now to offer state-specific subscriptions, so that the podiatrists in New York can sign up for and pay for just the amount of CME credit that they can earn online. So this will be a customized product. And with that, we’re going to have a reminder system, so that when your CME year is coming due, we’ll remind you that, you know, you need to complete this by a certain date.

 

We have just introduced a new board review product that’s – which is our curated group of lectures that are needed to prepare for board certification in podiatric medicine and surgery. And that series is now available online and it’s being packaged with the new review text that the American College of Foot and Ankle Orthopedics and Medicine, which is now, they’ve just changed their name gladly to the American College of Podiatric Medicine, actually, so they shortened it.

 

And – but they just published the third edition of the review text and we have that available on our website packaged with the lecture series and with another product called, Boards By The Numbers. So that’s available on the site.

 

Our lectures now work equally as well playing on an iPhone or a tablet, and a computer. So – and we get more access from the non-PC platforms than we do from the PC platforms now. So that’s something that’s pretty new and it was quite a real challenge to offer that.

 

Tyson Franklin: I can definitely say that big advantage – like on your phone, if people are – on – using public transport and travelling, is being able to access and, you know, consume information on their mobile phone or around, you know, iPad, not so necessarily having to pull out a computer and having to work through something.

 

Alan Sherman: It’s what the people want.

 

Tyson Franklin: Got to give them what they want.

 

Alan Sherman: Yeah. Give them what they want. And it’s a general principle of publishing that states that you want to deliver your content in whatever form your audience wants to receive it in. And the wonderful thing about the Internet now is that we can deliver it in multiple forms simultaneously.

 

Tyson Franklin: Yeah.

 

Alan Sherman: So that’s allowed individuals like you and I to reach a broader audience to use something valuable for them where it used to take a company, now an individual can do it.

 

So Bill Gates in 1995 wrote a book called The Road Ahead. And in this book, he used the term – he didn’t invent the term, but he used the term “narrowcasting”.

 

Tyson Franklin: Okay.

 

Alan Sherman: And the way he imagined that, was that in the future, an individual or a small company would be able to publish to an interest group, a small interest group and the interest group doesn’t have to be very large, they just have to have the same interest. And that’s all become – we take that for granted today that, you know, you’re reaching a few thousand podiatrists because they’re interested in what you bring to them.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And you don’t have to reach 300,000, maybe you can do something very valuable with a few thousand.

 

I feel the same way. I, you know, our mailing list is about 23,000 now and that’s people, that’s podiatrists and people in the industry. And we’ve gotten to the point where we’re reaching everyone that wants to receive our stuff. And I love that, it’s – there’s a, you know, there’s a efficiency in that which I really enjoy. And if you ever to get tired of it, you just click unsubscribe at the bottom.

 

Tyson Franklin: Yeah. No, but it’s true like I mentioned before like I do the – I spoke in Atlantic City last week. And my talk was on this Riches and Niches. And I was comparing my original podcast, It’s No Secret With Dr. T., to the Podiatry Legends Podcast. I told then how they’re completely different podcasts, except one is a small business and marketing podcast, which is very broad and it’s a big genre, that’s it’s actually aimed at and the Podiatry Legends Podcast is a lot more niched down and it’s narrowed.

 

And that podcast gets two to three times more listened per episode than It’s No Secret with Dr. T. Podcast, even though the guests on It’s No Secret With Dr. T. are so broad and varied and interesting, but podiatrists are looking for podiatry information. And I think podiatrists are going to learn from it and your patients are looking for specific information. So if you go to school in a particular area, maybe niching down in your podiatry business is a good thing as well.

 

Alan Sherman: Great advice. Find an area of practice that is underserved in your area or that you can do in a slightly better way than the other folks in town, and focus on that, that’s just really great advice. I recall some advice my dad gave me when I was looking for a career.

 

And like a lot of podiatrists, I was interested in being a doctor and I didn’t – hadn’t really picked a specialty and dad gave me advice when I didn’t get into medical school. He said, “You’re well-served to try to find a small pond and be a big fish in it.”

 

And I really feel that, not that I’m such a big fish in podiatry but I think that the lesson is that it doesn’t have to be a very big niche for you to be a success in it. It can be a community of runners, it could be ballet dancers in your town, it could be a support group for patients with diabetes. But find that niche. At our residency at summits we always have these talks called Life Skill Talks.

 

Tyson Franklin: Yeah.

 

Alan Sherman: Not so much practice management but just managing your career and we’ve had many talks about marketing your practice and this same advice that you just gave is so widely recognized that you just need to develop one strong niche and a whole practice can be built surrounding it.

 

Tyson Franklin: Well, it’s funny because I was doing it. My presentation was to a group of podcasters, yet I told my podiatry story from having my first practice in Cannes to setting up my second one 800 kilometers away or 500 miles and just picking one particular part of podiatry and saying, “That’s all we’re going to do in this town and see what happens.” What took me eight years to build in Cannes, took me 12 months in Macai, in another town that was so far away, and all of the podcastsers were just going, “That is just amazing. Why did we just set something up so far away,” for starters, but we just –

 

Alan Sherman: You got smarter as you got older.

 

Tyson Franklin: Well, what I was trying to do was I set up that far way because I didn’t want the second clinic to be influenced in any way by the first clinic. I want to know was the systems of marketing I put in place, was that what made the business a success, not just my longevity of being in the town. And we proved they did it, but niching down was – that was key and that was the point I was trying to get across to this podcasting group, that if you’ve got a podcast which is really broad, yeah, don’t forget why you started podcasting but maybe niche it down and you’re going to get more success. And I think it relates to podiatry, it relates to everything.

 

Alan Sherman: One of our most popular lectures that we do currently at our conference is social media marketing.

 

Tyson Franklin: Yeah. I could see it would be.

 

Alan Sherman: It’s something that isn’t familiar to people my age. It’s much more familiar to the milllenials, but still, to use it well, there’s a lot to learn.

 

And that’s an example of an outside conference that a podiatrist could benefit greatly, by attending, to learn how to do their own social media marketing.

 

Tyson Franklin: Yeah. There’s actually a big – so, which conference do you actually talk about that? Is there a specific one that – where you talk more about a little bit of marketing or practice management or it just pops up?

 

Alan Sherman: At every one of the conferences, that’s popular. So, we’re required by our accreditor to do a survey after each conference. So, we take that very seriously, both because it’s a requirement and also because the data is so important to us.

 

We want to – given them the lectures that they most want to see. And I’ll share with you, just a common result of those. Almost everyone that we do, shows the number one topic that they ask for is practice management. So, even though the conference is – designed for practice management, we always have a bunch because they’re interested in that. Take a guess what the number two topic that they’re – they want?

 

Tyson Franklin: I’ll take a wild guess and I’ll probably be wrong, marketing?

 

Alan Sherman: Not practice management at all, it’s a clinical topic.

 

Tyson Franklin: Okay. I don’t know, heal pain?

 

Alan Sherman: Biomechanics.

 

Tyson Franklin: Okay, yeah, okay, that makes sense.

 

Alan Sherman: Podiatrists feel they need to know more biomechanics and they want that education.

 

Tyson Franklin: Yeah.

 

Alan Sherman: So, that’s consistently the number two request that we get from our attendees.

 

Tyson Franklin: And what’s really funny is, yeah, I was talking to another – to an association that was running a conference, and I said, well, actually the most recent Australian Podiatry Conference that was held in Adelaide.

 

In which we host – three days of the event, and I spoke to someone from the conference who said, “You do not have one business or practice management related talk over the whole three days,” and I said – and they said, “Because nobody has requested that,” and I’m like, “Bull. I don’t believe you because when I talk to people, that’s a thing that comes up constantly all the time.”

 

They want to run a bit of practice, they want to manage things betters, help with HR, help with marketing, yet they were saying that nobody was interested. I think they are either surveying the wrong people or they didn’t get in their own little committee, and they’re going, “What are we interested in? We’re all in academics. What should we put on the agenda?”

 

Alan Sherman: There’s a growing – quickly growing trend of practices in the United States, major practices merging, and forming groups. Is that also happening in Australia?

 

Tyson Franklin: Yeah, a little bit, but I have noticed it in America. A lot of them joining together in surgery centers and stuff like that.

 

Alan Sherman: So the last survey that I saw, showed about 50% of podiatrists in solo practice and maybe even less than that now, so – whereas we used to be small businesses and we would all have to do everything. Join or form a group practice and you don’t all have to do everything. Some can focus on the clinical medicine, some can focus on the marketing, the practice, some can focus on the running of the practice.

 

And it’s really better now because we were not selected for our skills in business. No doctors were – there are very few people who go into medicine because they intend to be a great business person.

 

They go into medicine because they want to treat patients and they want to be, you know, valuable addition to society. But yet, 30 years ago, we were all called upon to be business people. And many of us are not well suited for it and don’t have the talents.

 

Looking back – I mean I’ve learned a lot of business along the way in my practice and more since with my new businesses, but if I had to do all over again, I would have gladly worked in a practice where I didn’t have to do any of that stuff and I just would have focused on treating patients. A lot of practices hire non-doctors to do this now. And I think it’s really better for everyone. Yet, there are some people who want to do all of it. There’s always going to be a place for them in practice, but I think that more people’s talents are being served well now by the group practices.

 

Tyson Franklin: Yeah, I think it will happen more in Australia even though we’re still majority, yeah, small business owners. And I always – like I always enjoyed the business behind podiatry right from the start, but then I didn’t realize how much I enjoyed until probably 10 years into practicing that I realized, well, I really enjoy the business side of things, then became, yeah, a lot more fun doing it. I think it was more of a challenge than anything else.

 

Alan Sherman: I also took it as a challenge and liked it for that reason. But honestly, from the years 1981 when I started to 2005, the amount of time that I had to spend in the management of the practice so greatly increased. It was almost 50% by the time it’s, you know, between the acquiring new patients, keeping up with the regulatory trends.

 

Now, the MIPS and the MACRAS, I mean I don’t know how they do it. I don’t know how a single practitioner keeps up with all that stuff and spends all that time, how much time do they have left to see patients?

 

Tyson Franklin: Yeah, it’s true.

 

Alan Sherman: You know, it’s gotten to be much more complex business. It was such a simple business when I started. I actually started before insurance was a predominant way of getting paid where patients would write a check when they left the office in 1981.

 

Tyson Franklin: Oh, you’re going way back – you’re going back to when Noah was building the ark and put in two podiatry centers.

 

Alan Sherman: Yeah, it was. And he had podiatrists on it.

 

Tyson Franklin: Yeah. Now, he had two podiatrists because he had to bring them.

 

Alan Sherman: He had to!

 

Tyson Franklin: But, no, like I think a lot has changed in podiatry over the years. I think a lot of it has been fantastic changes, especially with some of the research and technology that is now in profession. But I do agree, the people work in compliance in all aspects of podiatry is a lot more now than what it used to be.

 

Alan Sherman: I think that’s one of the main drivers for the group practices. So you have a – you join a company that is already doing that very well.

 

Tyson Franklin: Yeah.

 

Alan Sherman: And your success is more assured because, look, coming out of residency, how much of that stuff do you know? You know, you may be confident or beginning to be confident as a surgeon and you’ve treated podiatric medicine patients, you’ve treated some trauma, but how can you be confident running a podiatry practice at that point in your career? It’s difficult. Yet some people are still starting practices. I’m always amazed and admire people that start solo now. It still occurs, but it’s very rare.

 

Tyson Franklin: Yeah, Australia is still majority of people will solo practice and they just – and work from there. So we’re not as – I think it’s still easy over here to do that. We just could.

 

Alan Sherman: Yeah. I mean keep that up as long as you can. That seems like the good old days here.

 

Tyson Franklin: Oh yeah, yeah, still good.

 

Alan Sherman: A very popular lecture that we’re having at the Resident Summit next week in Chicago is how to get your first job. So it’s not how to set up a practice, it’s how to get your job because that’s – I’m going to say that more than 95% of podiatrists seek a job after residency. Even if it’s working for a private practice or small practice, it’s a job. But more and more of them are going to work for these large group podiatry practices. And I would love to see the figures on this, but I think there’s between 5% and 10% of graduates of residency programs are going to work for orthopedic practices now. So at least 5% or maybe 10% now.

 

And those are highly coveted jobs where their life is, you know, not that much different but a little different than they would be if they worked for a podiatry practice. And the orthopedists don’t particularly care whether it’s a foot and ankle fellowship training orthopedist or podiatrist, they just want to do the work and they want to get along with them.

 

Tyson Franklin: Yeah.

 

Alan Sherman: So that’s a whole new thing, but with, you know, the standardized three years surgical training programs, there are a lot of graduates of residency programs coming out now that are very attractive to orthopedic practices.

 

Tyson Franklin: Yeah, it makes sense. So Alan, we’ve been talking for well over an hour now.

 

Alan Sherman: Yeah.

 

Tyson Franklin: Which has gone really fast. So have you got any parting tips? Before we finish up, any final words you’d like to say to anybody listening to this right now?

 

Alan Sherman: You know, what I hope – I know that we’re reaching podiatrists all over the world…

 

Tyson Franklin: Yes.

 

Alan Sherman: …with this podcast. I think podiatry.com, the online lecture series is under utilized by podiatrists outside the United States. Only about 10% of the use of the site is from outside the United States, but more than 10% of the podiatrists in the world are outside the United States. So I would encourage them to use it. When they sign up for the first time, we give them $40 of credit to test it out and use it. So they can try it out, they can watch 2 hours of lectures for that $40 and I would encourage them to do that.

 

And I think they’ll find that spending a half hour on a particular day watching a talented teacher give a lecture in podiatry could be very mind expanding for them and easy to fit into their professional lives. It could be done in-between patients. It could be done when they get a no show. We all get no shows from the office.

 

Tyson Franklin: It happens.

 

Alan Sherman: It happens, you know, and you can use that half hour to improve yourself professionally. So if I had any message, it’s for our podiatric colleagues from outside the US to check out podiatry.com.

 

Tyson Franklin: Okay, that is fantastic. So Alan, I want to thank you for coming on the Podiatry Legends Podcast. It’s been fun. As always, always, always learn something from every single guest, so thank you very much.

 

Alan Sherman: My pleasure. Thanks for having me.

 

Tyson Franklin: Well, I hope you enjoyed listening to Dr. Alan Sherman today from PRESENT e-Learning Systems. I love the history of how this all developed going way back – way back to 1992 when he actually started through to ’95 when he kicked off Podiatry Online and then moving forward from there.

 

And it sounds like it’s a great resource. If you’re looking for a place to find more education, information and to attend conferences, just make sure you go on to their website, podiatry.com, which is pretty easy to remember.

 

So I just want that quote that he mentioned. You’re well served to find a small pond and be a big fish. I think it’s really important to remember. And I’m always talking about nicheing down. I just think it’s something you need to do in your podiatry practice. And it is one of the topics I will be talking about at my podiatry marketing workshop, Success Leave Clues, on Saturday, the 23rd on the Gold Coast. So if you’re going to be free that day, make a way to the Gold Coast. I’ve only got 20 places available in total and it’s already 50% booked up and we still got about two months to go. So I’m really, really looking forward to it.

 

Remember, if you’re enjoying this podcast, please tell your podiatry friends that exist, and if you get the urge, I’d love a review on iTunes or whatever podcast platform you listen to. It’s probably in your hand right now on your phone.

 

Okay, that’s it for me this week. Look after yourself, look after your family and I will talk to you again next week. Bye for now.

 

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