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09/22/2018
RESPONSES/COMMENTS (PM EDITORIALS)
From: Christopher Smith, DPM
Thank you, Dr. Block, for your insights into the identity crisis within podiatric medicine (or should I just say “podiatry”?).
I don’t want to sound angry, but I am frustrated by the direction of the APMA in their pursuit of the MD degree for podiatrists. Your data would suggest that the “surgeons” are directing that organization and they have an agenda that does not reflect podiatry in general. I hope your editorial starts a dialogue. I am proud of the initials after my name. I started my professional training when we were “chiropodists” and I watched us grow, evolve and mature. Alas, the egos of a minority are forcing an agenda on the majority.
Christopher Smith, DPM, Ferndale, WA
Editor's note: The APMA has never advocated for the MD degree.
Other messages in this thread:
06/17/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Daniel Chaskin, DPM, Jon Purdy, DPM
Board certification should be available to every podiatrist, and no podiatrist should be left behind. All licensed podiatrists should have the ability to take a board certification exam. If they pass, they pass. If they fail, they fail. If cases are required to be presented, the cases should be legally within the scope of podiatry practice for any initial board certification.
Daniel Chaskin, DPM, Ridgewood, NY
Dr. Jacobs, you make perfect sense. This day and age we should all be trained to pass one surgical and podiatric medical board. However, we still have those in the profession who were not surgically trained and some who have been eliminated from the possibility of becoming board certified due to the ambiguous “passage of time” that deemed them ineligible.
It might make sense to have a podiatric medical certification with a sunset for those in need. The other myriad of specializations could certainly have proficiency testing and be deemed something short of “certification” but something of prestige to hang on the wall for all to admire.
Jon Purdy, DPM, New Iberia, LA
06/17/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1A
From: Ivar E. Roth, DPM
Dr. Jacobs is again spot on with this current opinion. He is right that all these miscellaneous boards are silly. Get boarded after residency with the one board and if you want special recognition, get a certification from that board that has rigorous qualifications for that specific area. Again Bravo Dr. Jacobs; now let’s get this done once and for all.
Ivar E. Roth, DPM, Newport Beach, CA
06/14/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Allen Jacobs, DPM
Personally, I would approach things somewhat differently, Dr. Purdy. I think we should have one board and one board only. We should be in podiatric medicine and surgery. If a person has a particular interest in some area, for example, wound care, limb, salvage, sports medicine or whatever, then if you really feel, compelled to do so offer a "certificate of added qualification”.
I personally do not feel this is needed or would benefit any individual practitioner in the long-term, I think this is a far better solution than continuing with a ridiculous number of board certifications in podiatry. If I treat an athlete with a Jones fracture, my treatment is going to be identical for that patient whether I am “board-certified in sports medicine” or ...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
06/14/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1A
From: Paul Slowik, DPM, Rod Tomczak, DPM, MD, EdD
Kudos to doctors Rogers and Jacobs for once again being the voice of reason. It’s podiatrists’ pettiness that disempowers us.
Paul Slowik, DPM, Oceanside, CA
I agree with Dr. Jacobs and his views he shared with us in the June 13th PM News. It was quite serendipitous that I came to The Ohio State University College of Medicine. On May 19, 1995, one of the podiatry students who is now a faculty member at the University of Alabama, Birmingham called and asked me if I had seen the advertisement for the faculty position at Ohio State. To be honest, I hadn’t, but upon inspection it looked intriguing. I had a friend who was a pediatric spine surgeon, Tom Kling, MD at the University of Indiana, and I called to ask him if he knew the chair of orthopedics at Ohio State. He said he knew him quite well.
He said he would call him right then for me but warned me that Shelly Simon, MD was a well-respected foot and ankle surgeon in the orthopedic community and warned me that it was, “Shelly’s way or the highway,” but I would be fine. Not more than 30 minutes later, Shelly called me and asked if I could come the following Wednesday to be interviewed on...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/13/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Allen Jacobs, DPM
I had an interesting conversation with our chief of orthopedics. We were discussing the two board issue in podiatry. Non-podiatrists find this to be confusing and find this sets us apart from the remainder of medicine. He feels this leads to a lack of credibility for our profession. He looks at orthopedic surgery as an example. Regardless of the residency completed, there is one orthopedic surgery board. If you are an orthopedic surgeon, certified or not, you cannot apply to our hospital for spine privileges unless you demonstrate adequate experience in spine surgery. We can go on from there.
You have orthopedic surgeons who complete fellowships and concentrate, for example, in upper extremity surgery, sports medicine, pediatrics, oncology, and so forth. The point is, however, that regardless of how narrow, the scope of practice an orthopedic surgeon elects to practice, the orthopedic surgeon still must satisfy the requirements for one board. There are not separate boards for feet, shoulders, knees, hips, infectious disease, and...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
06/13/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1 A
From: Jon Purdy, DPM
I don’t understand why this has to be such a convoluted issue. You have ONE board with multiple certification types. And as much as I’m tired of repeating myself, it bears repeating. We ALREADY have that type of board, called the “American Board of Multiple Specialties in Podiatry.”
Currently, we have a surgical board that splits the foot, so we have to say we are “board certified” then denote for which structures of the foot. This, along with multiple other boards, is just confusing to the public, insurances, the medical system, and it further marginalizes us.
Why not present our profession with one board, then within that board, get certified in whatever the heck you want? Be it podiatric medicine, surgery, wound care, limb salvage, or all of the above, we are represented by one certification body.
Jon Purdy, DPM, New Iberia, LA
06/12/2024
RESPONSES/COMMENTS (PM EDITORIALS)
RE: APMA Policy 2-24. One Board Certification in Podiatry (Lee Rogers,, DPM)
From: Richard M. Maleski. DPM, RPh
While I appreciate the points Dr. Rogers brings up, I still contend that there is a strong possibility that some podiatrists will have difficulty attaining board certification status if the surgical portion of the board remains the same as it is now. I've had the honor and privilege of being on the faculty of the University of Pittsburgh residency program since its inception in 2001, and also on the precursor program in Pittsburgh before that. I've helped train over 130 residents and at least twice that number of students over the 30 plus years of my career. I've been a Residency Evaluator for CPME and have evaluated about a dozen programs. Not all of the aspiring podiatrists that have rotated through our program and that I observed in the on-site evaluations over the years have shown the aptitude or the interest in pursuing surgery.
Granted, this number is very low, but it exists, nonetheless. And why is this pertinent to podiatry versus medicine? In medicine, medical students have 4 years of medical school to determine if they are going to gravitate to a medical specialty or...
Editor's note: Dr. Maleski's extended-length letter can be read here.
06/11/2024
RESPONSES/COMMENTS (PM EDITORIALS)
From: Brian Kiel, DPM
My esteemed Dr. Lee Rogers. Without my generation, yours would not be where it is today. R-E-S-P-E-C-T!
Brian Kiel, DPM, Memphis, TN
06/10/2024
RESPONSES/COMMENTS (PM EDITORIALS)
From: Lee Rogers, DPM
Respectfully to Dr. Maleski, the One Board proposition wasn't developed for his generation. It is developed for the current and future generations of podiatrists who are ALL "surgical podiatrists." Since 2003, according to CPME standards, EVERY residency graduate has been trained in podiatric medicine AND surgery. Whether a podiatrist chooses to do surgery after residency is irrelevant. Just like all OB/Gyns or ophthalmologists are trained to perform surgery and some decide to focus on a medical practice afterward, they are still board certified in what their residency training was.
Other medical specialties don't have 2 boards. There is only one recognized board for every MD specialty, many containing a mixture of surgery and non-surgery. Subsequently, your privileges at the hospital or ASC are determined by your education, training, and current experience (surgical cases).
Lee Rogers, DPM, San Antonio, TX
06/07/2024
RESPONSES/COMMENTS (PM EDITORIALS)
From: Richard M. Maleski, DPM, RPh
Once again, I ask the same question that I asked about 6 weeks ago: how are non-surgical podiatrists going to get board-certified in the surgical portion of the exam if they don't do surgery? There is no way any physician who is not experienced in surgery can pass a surgical board. This is true of any medical discipline, not just podiatry. This is the reason that 2 boards were instituted. Many podiatrists simply do not do surgery, for a variety of reasons. What is going to happen to them if they no longer have an opportunity to get certified?
Richard M. Maleski, DPM, RPh, Pittsburgh, PA
06/05/2024
RESPONSES/COMMENTS (PM EDITORIALS)
From: Alan Sherman, DPM
And as far as APMA Policy Proposition 2-24, amen to that. May we again have the foresight and strength to standardize podiatry to the model that general medicine has established, so that we may fully integrate into the greater healthcare system and fulfill our destiny as a medical specialty.
Alan Sherman, DPM, Boca Raton, FL
04/10/2024
RESPONSES/COMMENTS (PM EDITORIALS)
From: Amol Saxena, DPM, MPH
One metric that has not been critically evaluated is $/minute/sq ft or $/sq ft/minute, both gross and net. This can help the provider see the cost of bringing in new equipment or an associate, particularly if there is empty office space.
Amol Saxena, DPM, MPH, Palo Alto, CA
02/12/2024
RESPONSES/COMMENTS (PM EDITORIALS)
From: Richard M. Maleski, DPM, RPh
I was surprised and dismayed to see the average net profits of DPMs this past year. Basically $103,000 for solo practitioners and $149,000 for partnership practitioners. I decided to search the Bureau of Labor Statistics website and saw that for 2022, the average podiatrist reported a salary/profit of $148,000, so I guess the PM Annual Survey is reasonably accurate. Using the same BLS website, RNs made an average of $81,000, pharmacists $132,000, cardiologists $339,000, family practice physicians $230,000, and orthopedic surgeons $526,000.
Is it any wonder that we have a difficult time getting enough qualified students to apply to our schools? Knowing that statistics can be analyzed from different points of view, I find it hard to believe that DPM salaries are, in reality, that low. However, if these numbers really are true, then we as a profession need to take a long hard look at how we are functioning within the healthcare arena. I have opined in this forum in the past that we need to change our education/training model so that our graduates can become full-fledged physicians, and thus function completely as physician specialists, and not merely technicians. If these numbers don't open our eyes, I don't know what will.
Richard M. Maleski, DPM, RPh, Pittsburgh, PA
10/10/2023
RESPONSES/COMMENTS (PM EDITORIALS)
From: Bob Sage, DPM
I am an avid reader, not so common commenter of PM News. Reading the PM September Editorially Speaking, I couldn't agree more. Thank you for encouraging our fellow colleagues to join APMA and to speak at career days.
APMA has been doing its best to put more money in the pockets of our members by doing things like making sure we were viewed as essential during the shutdowns. Fighting the "Podiatry-Specific" E/M codes and enabling us to bill like all the rest of our colleagues by "time" and "risk". That victory alone has given us an enormous financial benefit. Passing the VA Parity Bill, putting podiatrists in the same pay category as other physicians. Stopping the mandatory Cigna -25 modifier policy, adding money in both reduced costs to our offices and increased...
Editor's comment: Dr. Sage's extended-length letter can be read here.
10/04/2023
RESPONSES/COMMENTS (PM EDITORIALS)
From: Joseph Cortez, DPM
I really enjoyed the September editorial on threats to podiatry. I was particularly sad to read "Millennials are not joiners”. I am not a joiner either and I have many reasons why I left. The medical associations do not reach out to new practitioners, unless they want a donation. When I started out, I was reading how the medical associations fought to allow podiatrists to perform amputations and have hospital privileges. That was great, but I am just getting my feet wet and haven’t seen a patient yet. What I am saying is, if they want professional loyalty, they should offer help and guidance to support success in our profession...even if they just made a phone call to see if there was anything they can do to help the young practioner avoid being cannibalized. A simple pamphlet with important information and numbers to contact, given to new licensees would be a simple gesture towards sowing membership.
I also think the California Podiatric Medical Association (CPMA) should not require joining the APMA to become a member. In these difficult times, organizations that are supposed to help the profession should be looking for ways to give their constituents a break. When I was a member, I did reach out to the CPMA for advice, but they could not bother to provide any guidance. This was a reason I canceled my membership. If you want people to give you their support, then you need to be in contact with them, and show you care, before membership is up for renewal.
Joseph Cortez, DPM, Simi Valley, CA
08/17/2023
RESPONSES/COMMENTS (PM EDITORIALS)
From: Ivar E. Roth DPM, MPH
It seems clear to me that we as podiatrists need to prioritize our goals and strategies. A uniform scope of practice seems the most obtainable and, in the end, will be to our great benefit to have this instituted and stabilize OUR profession. I like Dr. Barry Block’s idea to start with neighboring states Georgia and Florida and expand from there. APMA, let’s focus and get this done.
Ivar E. Roth DPM, MPH, Newport Beach, CA
08/16/2023
RESPONSES/COMMENTS (PM EDITORIALS)
From: William A. Wood, DPM, MPH
The profession of podiatry must have parity within its ranks before it can ask for parity with other professions or from insurance bodies. Perhaps the APMA can establish a path toward achieving this by looking at the path toward a national practice act utilized by allopathic, osteopathic, and dental physicians.
William A. Wood, DPM, MPH (Ret.), Groveland, FL
08/11/2023
RESPONSES/COMMENTS (PM EDITORIALS)
From: Rod Tomczak, DPM, MD
Since the state legislatures pass the laws governing the scope of practice in each state, how would you go about accomplishing the task of convincing all 50 legislatures to agree on a scope of practice? It might be easier to pass the 28th amendment to the US Constitution defining a podiatric scope of practice. The Equal Rights Amendment still hasn't been passed, so taking up the question of what podiatry should be in all the states and territories seems to be a long way away.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
Editor's Comment: The Chinese philosopher Laozi said, "A journey of a thousand miles begins with a single step." Attaining a uniform podiatry billl would require the APMA to get neighboring states to Florida and Georgia to adopt their scope of practice and continue to spread this process to neighboring states.
Of course, I have always supported a different path such as changing our degree. Regrettably, even though PM News polls show that the majority of practicing podiatrists supports this, podiatric leadership does not.
10/24/2022
RESPONSES/COMMENTS (PM EDITORIALS)
From: Robert Kornfeld, DPM
I have been reading the posts about the high cost of being a podiatric surgeon and would like to chime in for those of you who are sick and tired of fighting with insurance companies and being forced into high volume, high expense practices. I am a 1980 graduate of NYCPM. When I went into my own private practice in 1982, there were only cash patients, Medicare, and indemnity plans that paid 80% of everything you billed (there were no fee schedules back then). Some insurance companies paid based on location and estimated expense levels, but most paid 80%.
That golden goose died when podiatric surgeons started billing for multiple procedures with no bundling. This led insurance companies to look for more cost-effective (profitable) models. Hence, managed care hit the scene. Now, you were at the mercy of the...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
10/21/2022
RESPONSES/COMMENTS (PM EDITORIALS)
From: Vince Marino, DPM
I am glad my post in response to Dr. Block’s PM editorial about the “High Cost of Being a Foot & Ankle Surgeon” has provoked some very good responses and initiated some thought and discussion. But I feel I must issue a clarification - I am not against performing surgery and still do a fair amount of surgery when the clinical circumstances require it. Yes I do minor office surgery which certainly reimburses at a higher rate than outpatient hospital and surgicenter.
Yes, we need to be able to teach our residents who wish to perform surgery and Yes, most of my surgeries are done at a surgicenter, which at least in my area, is infinitely more streamlined and efficient than going to the hospital. In fact, there are probably only 4 reasons I use the hospital for outpatient surgery: Patient BMI...
Editor's note: Dr. Marino's extended-length letter can be read here.
10/20/2022
RESPONSES/COMMENTS (PM EDITORIALS)
From: Don R Blum, DPM, JD
“Total reimbursement: $1,035.17 (private insurance) $1,293.97 (Medicare)
Time Out of Office= Approximately 3.25 hours ( 30 min travel + pre-op- 2.25 hours for procedure- 30 min post-op and travel back to office).
Hourly rate comes to $1035.17 / 3.25= $318.51 (Medicare) $398.14 (private Insurance)"
Dr. Marino left out of the hourly rate: the number of post-operative visits (no reimbursement) and the cost of your staff to schedule and pre-certify the procedures. With those items, your hourly rate is much less than $318.51/hr. You could also add in the cost of an appeal when the insurance only pays for the bunionectomy and not the other procedures, stating that the other procedures are included in the fee paid for the bunionectomy.
Don R Blum, DPM, JD, Dallas, TX
10/19/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 3
From: Kathleen Toepp Neuhoff, DPM
I have appreciated the discussion on the costs of hospital surgery vs clinical outpatient care and certainly agree that income per hour is much higher in the office vs the OR. As was pointed out, some of this is because of the fees. Some of it is also because of the inefficiencies of OR surgeries. This can be improved by using surgericenters and scheduling back-to-back procedures. However, the hourly reimbursement rate is also improved by performing many procedures such as exostectomies or hammer digit correction in your office.
Even if you cannot meet the criteria for a surgericenter, it is not difficult to dedicate a room to sterile surgery. Infection rates are generally lower in this environment than in hospital ORs. Many patients are willing to have procedures done with ...
Editor's note: Dr. Neuhoff's extended-length letter can be read here.
10/19/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Steven Kravitz, DPM,
Thank you, Vince Marino, DPM for a very compelling argument in your well drafted post as well as comments from Dr. Block that preceded your post. It's time for podiatry to get back to its grass roots, decrease the "over emphasis" on surgical procedures, and increase emphasis on biomechanics and diagnosis of medical conditions, etc. In the past, I ran a general practice emphasizing wound healing and directed a surgical residency program that had as many as 35 internal medicine residents rotating through it yearly. I was fortunate enough to run a private practice while teaching at TUSPM, including at the clinic. During those years, surgery paid substantially more than it does now, with decreased costs. Even during those times when surgery was more lucrative, the biomechanics therapy of my practice was a very important and consistent aspect.
I used basic Root theory for my biomechanical examinations, (approximately $200 for 30 minutes) with a five-minute consultation at the end of the exam, explaining the results. Orthotics were charged separately, I believe $500- $600 at that time. It requires much experience to analyze the nuances of foot pathology, especially in those with complicating diagnoses. Today as I continue to be involved with wound healing, these principles are still core to my therapeutic approach.
I encourage all the young practitioners to more carefully look at the subspecialty. Embrace it, read more about it, and go to courses that can teach you more about it. You can develop a very successful practice with minimal liability, very successful therapeutic results, and happy patients who will continue to refer more patients to you.
Steven Kravitz, DPM, Winston Salem, NC
10/19/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1
From: Ivar E. Roth, DPM, MPH
I would like to opine from a concierge, no insurance accepted point of view. I hope to enlighten and encourage those podiatrists who feel they have the skill and knowledge to opt out of insurance. I have been in practice for 37 years and completed a 3-year surgical residency when the typical was one year. I feel I offer excellent services and care for which I charge upfront.
I charge $4,000 for a standard Austin bunionectomy; for the Weil, plantar plate, and hammertoe, I charge $5,000, since it is a secondary procedure that I combine/bundle as second ray surgery. I charge 50% for the second procedure, $2,500 for a total of $6,500. This includes all post-op care, x-rays, and all supplies dispensed by me. It is a one and done fee inclusive until they do not need my services from the surgery anymore. I hope this information inspires some of my colleagues to follow suit; we deserve to be compensated for our excellent work.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
10/18/2022
RESPONSES/COMMENTS (PM EDITORIALS)
From: Keith L. Gurnick, DPM
Irrespective of our fee-for-service contracts and taking into account all of the services that podiatrists can provide, we definitely make more money per minute staying in our offices and going from room to room seeing patients. As we all know, some procedures and services seem to pay less than we feel is appropriate for the time and skill and effort involved (and the aftercare); and also procedures done in the hospital or at surgery centers pay us less than if the same surgery were done in our office setting. If your career is only about the money and efficiency, then never leave your office to do a house call, never drop off a sample to a patient at home, and never do a consult or treat a foot ulcer in the hospital.
However, the beauty of our profession is that each doctor can decide what is best for them. Personally, I have found that after 40 years of private practice, the "outside of the office" surgeries that I still do, are both enjoyable and rewarding, both to myself and to my patients. Even if my overall "dollar-per-minute" remuneration would be increased by focusing my attention to only in-office care or procedures, it is kind of relaxing to be in the operating room with the patient not talking, getting the job done, along with teaching our surgical residents (our profession's future).
Keith L. Gurnick, DPM, Los Angeles, CA
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