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11/08/2018
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Allen Jacobs, DPM
It is not appropriate to willfully misrepresent facts to a patient. Tell the patient the truth. You are paid less for multiple procedures performed concurrently. You are not willing to accept the reduced payments. The patient should be made to understand that you utilize the same degree of care, time, cost, and expertise for each procedure.
If you are found negligent in the performance of a second or third procedure, I do not believe the jury award or settlement by the carrier is reduced 25 or 50 or 75 percent. Just tell the patient the truth. Misrepresentation is always unethical regardless of any well-intentioned reasons for doing so.
Allen Jacobs, DPM, St. Louis, MO
Other messages in this thread:
05/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: George Jacobson, DPM
It is really simple. The applicant pool is showing the lack if interest in spending 7 years to become orthopedic surgeons of the foot. It takes 7 years to get licensed even if you don’t want to primarily practice surgery. How many medical students want to be orthopedic surgeons? We chose podiatry so we could do it all, not just surgery. How many of us would not have chosen podiatry if it took 7 years to get licensed? That is 11 years post high school graduation.
A lot could be done in 11 years, without the expense. One could be 11 years closer to a pension, have savings, and a family. We may have ruined a simple path to success that we knew as podiatry.
George Jacobson, DPM, Hollywood, FL
05/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
On October 19, 2021, The USMLE replied to the podiatry task force made up of our alphabet organizations. USMLE dealt us an unequivocal denial of our petition to take the USMLE in search of a plenary (not limited to body part) medical license. Some years ago, Len Levy, DPM persuaded Larry Jacobson, DO, the dean of Des Moines University, to allow a select group of DPM students to take COMLEX level 1 after the second year of school, around the time of the DPM boards, so our students were "studied up." Only 10% passed the COMLEX. We never told the students the results.
We do not teach the same curriculum of medical school. Because there is a 4-4-3 model does not mean everything is the same. We are not one childbirth and a bipolar patient away from and equal curriculum. The third and fourth years are miles apart as far as clinical experience goes, and there is no comparison. We do not have a month of dedicated pediatrics, ED, neurology, women's health and pregnancy, or psychiatry. Letting our students take these tests without the proper preparation would deliver a devasting blow to their self-esteem. Let's do things the right way rather than trying to sneak in the back door.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Paul Kesselman, DPM
There is no doubt that with the current class sizes we will cause our own extinction and we must do something about that. The question is will a DO degree accomplish that goal? Will students going to DO schools choose podiatry as a specialty, and/or are we to continue as a profession. In the mid ‘70s, there were five schools turning out a total of about 750 new graduates a year. Now we have more than double that number, and we are graduating nowhere near 750.
In the mid ‘70s and very early ‘80s, there were an insufficient number of residency programs. Now we can fill them all and some are not filled. So, we have gone places in the past fifty years or so since I first thought of attending podiatry school that I never thought possible. As for the negatives, we have no one but ourselves to blame by continuing to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Jon Hultman, DPM, MBA
We do not need a medical degree. What we do need is a medical license – a plenary license. We are the only medical-surgical specialty that does not have a plenary license. In California, the medical and orthopedic associations are willing to support DPMs in our quest for a medical license as long as we take “their test” – either the USMLE or a modified version of the COMLEX.
A dual degree (DPM/MD or DPM/DO) would get DPMs a medical license only if they completed a three-year DO or MD residency. DPMs would also need to complete a comprehensive podiatric residency to become board certified in podiatry. We do not need extra years of education, training, and expense because we already have the same education model as medicine – four years of undergraduate education, four years of professional education, and three years of residency (the 4-4-3 model).
Some medial schools are now testing programs to truncate medical school to three years if a student declares s/he wants to go into primary care. Does declaring a specialty at the front-end of professional education sound familiar? MDs and DOs have plenary medical licenses upon completion of residency programs. DPMs have a limited license upon completion of their residencies, but they can, and should be, the next degree to qualify for a medical license. We simply need to access either the USMLE or COMLEX to make the DPM degree equal to the MD and DO degrees.
Jon Hultman, DPM, MBA, Los Angeles, CA
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Evan Meltzer, DPM
If our podiatry days are numbered and our demise is approaching according to Dr. Tomczak, can someone explain to this old retired podiatrist why more podiatry schools have been recently established? When someone asks me what my profession is, I say that I’m a retired podiatrist. If the general public doesn’t know the scope of our field, who is responsible for disseminating that information?
New Mexico is seriously short of primary care MDs and DOs. As a result, nurse practitioners are often the first primary providers seen by new patients. One of my neighbors who typically accompanies his wife on our monthly hikes was absent from the last hike. When I asked Barbara where Jim was, she said, “Jim is having foot trouble and his primary care provider (a nurse) told him, there’s nothing else that can be done for your foot.” That naive statement just dismissed our entire profession! I asked Barbara a few basic questions about Jim’s complaint and then referred him to one of the several excellent podiatrists in the area whom I know personally.
Jim was fitted with custom orthotics and is doing well. I cringe every time I see TV ads from the “Good Feet Store.” After prescribing custom orthotics for over 40 years, I don’t ever recall a patient telling me that their back pain or foot pain disappeared after one day of wearing these prescription devices, let alone those (paid persons) who claim immediate relief by wearing the OTC arch supports dispensed by the Good Feet store. So, who’s responsible for educating the general public about our beloved profession? Why are there new podiatry schools being created if we are on our “last legs?”
Evan Meltzer, DPM (retired), Rio Rancho, NM
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
Although I agree with Dr. Udell's position about being satisfied with the DPM degree we received in the 1970s, I think he is missing my point. The PM News survey of current DPMs concerning their satisfaction with a DPM degree revealed that only 14% of the over 600 responses would settle for a DPM degree and a 3-year residency today if they had the option of earning a DO degree instead of a DPM degree. With the number of applicants to podiatry school dwindling at a rapid rate, it won't be long before podiatry schools will not be able to afford keeping their doors open. At the same time, DO schools have increased to over 35 institutions and offer more options to students when it comes to residency choices. I hope that a residency program offering a 1-year general internship and a 2- or 3-year foot and ankle program will evolve to keep the spirit and efficacy of podiatry alive.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
02/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Brent D. Haverstock, DPM
As usual, Dr. Jacobs nailed it on the head. We as a profession don't have a clue what we are or want to be, so how do we expect the public to know? Dr. Jacobs has talked and written about comparisons of podiatry to dentistry. It would appear to be a good time to revisit this comparison. I feel all graduating DPMs should complete a two-year residency that focuses on podiatric medicine, biomechanics, wound care, and minor procedures.
This would lead to board certification in podiatric medicine and those entering practice would be called "podiatrists". Then there would be a select number of podiatric surgical programs in the country, and those who are selected would complete another two years of training in foot and ankle surgery. This would lead to board certification in podiatric surgery, and those entering practice would be called...
Editor's note: Dr. Haverstock's extended-length letter can be read here.
02/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Kevin McDonald, DPM
I disagree with Dr. Jacobs' assertion that the number of podiatry school applications is down due to the name of state podiatry associations. I believe it comes down to the cost/benefit equation whereby salespeople at podiatry conventions can make more money than the average podiatrist without the time and monetary investments required to become a podiatrist, particularly in today's changing healthcare landscape.
While the non-monetary rewards of being a podiatrist are above average, the fiscal and time costs of becoming a podiatrist make the choice less appealing to many qualified people. Lowering the time and money required to become a podiatrist is a potential solution to the problem. Podiatry is a compassionate calling, but it also must be a sensible choice for the profession to thrive.
Kevin McDonald, DPM, Concord, NC
02/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Alan Sherman, DPM
Sometimes it is hardest to see that which is right in front of our faces, and particularly, if it has been growing there for some time. Allen Jacobs is right. While it is not the only factor, our devaluation of the name podiatry IS hurting applications to podiatry schools and general awareness as to what a podiatrist is. We should rethink this. Either we complete the process of becoming foot and ankle specialist MDs or we go back to using the term podiatrist and be the DPMs that we should be.
I continue to strongly believe that we need dual track residency education - a surgery track for the minority of residents who are deemed to be suited to be specialty foot surgeons and a medicine/general track for the majority of residents who will practice general podiatric medicine and wound care. One will refer to the other to provide complete care of the foot and leg.
Alan Sherman, DPM, Boca Raton, FL
01/16/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Rod Tomczak, DPM, MD, EdD
Is it? Probably, with 37 DO schools now open in the U.S. and Caribbean medical schools on the rebound after COVID to more than 50. Some Caribbean schools will accept just about anyone with tuition and boast a 95% Step 1 USMLE pass rate. They can make that claim because they only certify their better students who have a 95% predicted pass rate based on NBME practice tests to take Step 1. In most Caribbean schools, a high percentage of students are foreign. When I was in Riyadh opening a medical school there, the country of 35,000,000 had one American-trained podiatrist in Jeddah, Saudi Arabia which had a population of 5,000,000. Saudi Arabia is rampant with type 2 DM and this gentleman was revered for saving limbs instead of amputating.
AACPM states there were 1,000 applicants to podiatry schools for the 2023-2024 academic year and 711 students matriculated. That’s a 71% application to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
01/16/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Ron Freireich, DPM
When physician Medicare pay has decreased by 29% since 2001 - When only 42.86% of podiatrists are very satisfied with their careers - When the CEO of a 354-bed hospital where I am on staff recently stated in a newsletter, "Our operating margin continues to be negative due to lower reimbursement rates and higher operating expenses" meaning the hospital continues to LOSE money - When a recent article in Medscape reported that 49% of physicians surveyed feel burned out, and the NPs and PAs that were to help take stress off the physicians are now also complaining of burnout.
When a family member who recently went to the ER of a 193-bed hospital was diagnosed with pneumonia but could not be admitted because there were 80 other patients waiting to be admitted (several wings were closed due to staffing issues and two other nearby hospitals have closed within the last several years, overwhelming this hospital)...
Why would anyone want to choose a career in medicine when doctors and hospital insurance reimbursements continue to decrease, less than half of podiatrists are very satisfied with their career and almost 50% of physicians, PAs, and NPs are reporting burnout? It's not just the small podiatry school applicant pool we should be worried about. In my opinion, the whole medical system is imploding.
Ron Freireich, DPM, Cleveland, OH
01/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Robert Kornfeld, DPM
Dr. Udell asks, "What are the main areas bothering podiatrists?" I think this cannot possibly be in debate - it is the ridiculously low insurance reimbursements and the insane prior approval hurdles. Most podiatrists that I speak to enjoy treating patients. But they ABHOR what they are required to do and how little they get paid after so much training and experience.
I am PGY-44. The issues have not changed. We have been battling insurance companies for decades and LOSING. Continued negotiations will not make anything better. Just look at your Medicare reimbursement levels for 2025. Is there any other profession that continually has its earning power diminish year after year?
So here I am again...encouraging those who really wish to enjoy practice autonomy and eliminate the middlemen to stop telling themselves they can't create a successful direct-pay practice, or at least a hybrid practice. You absolutely can! Your current patient population is not who will honor you with direct payments. They come to you because you accept insurance. But there are thousands of patients in your area who are completely fed up with the system. And they definitely will come to you with the right branding and marketing. Remember, anything you tell yourself becomes your reality.
Robert Kornfeld, DPM, NY, NY
02/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Lawrence Rubin, DPM
I agree with Dr. Steinberg. From what I have observed and have been told, the curriculum in our schools has not kept up to the standards for today's podiatric physicians and surgeons to become successful in practice. A glaring, practical example applies to information that pertains to a podiatrist's personal financial success. It is my understanding that there is little if any classroom content on practice management and "The Business of Podiatry."
I don't find this surprising. Having been a podiatrist for 66 years, I have observed a long-time reluctance of our schools to include practice management and podiatric medical economics educational curricula. For example, right now, our entire healthcare reimbursement system is dramatically changing from a fee-for-service model to a value-based care model. In fact, in a recent issue of APMA News, there was a very informative article advocating podiatric practices transition from fee-for-service to value-based care.
I doubt whether current podiatry students are being informed that their future insurance reimbursement for spending an hour of preventive services, providing chronic care management (CCM) for a patient who suffers from lower extremity conditions such as diabetic peripheral neuropathy and peripheral artery disease. This already surpasses what they can earn in an hour for providing most surgical procedures that include post-operative care. Knowing this might influence a student to not become financially dependent upon providing major surgical procedures, especially if they are elective. Or, maybe even go, “Direct Care” and not accept anything other than cash payment. Who would deny that, forewarned is forearmed? Our students deserve to be better prepared for the future.
Lawrence Rubin, DPM, Las Vegas, NV
02/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: John Mozena, DPM
Dr. Daniel Jones brings up a great point! Maybe it’s time to revisit the idea of our specialty being absorbed by osteopathy or the allopathic schools. Is there really that much difference in our training these days? With so many medical and osteopathic schools, I’m sure there is room for our students and their money.
John Mozena, DPM, Portland, OR
02/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Daniel Jones, DPM
If there is one thing that schools are good at, it's taking money. With the federal government fully subsidizing all education at ANY cost, there is no incentive for schools to consolidate. And if you already have an MD or DO school set up, why not cast a larger net to get more money?
Perhaps the conversation with applicants goes something like this, "Oh, I'm sorry, you didn't have good enough grades to get into our medical program. Why not apply to our DPM program? You can be a foot and ankle surgeon! By the way, that will be 60,000 dollars a year for the next 4 years."
Who wouldn't start a program? 90% of the classes are the same. You only need to hire one or two podiatry professors and use the existing machinery already set up for your med students, and your med school now makes an extra million a year. Until CPME denies new schools from popping up, the number will continue to grow. Would that be a restraint of trade violation? Probably. So we will keep adding more schools as numbers of applicants dwindle to a point it's no longer sustainable, and podiatry gets absorbed by the allopathic and osteopathic professions.
Daniel Jones, DPM, Casper, WY
02/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Narmo L. Ortiz, Jr., DPM
According to an article published on March 27, 2023, in collegiategateway.com, "the latest figures put overall medical school enrollment at 96,520, an almost 18% increase over the past decade. This surge has been made possible by increasing class sizes, the opening of more medical schools, and government intervention to add Medicare-supported graduate medical education positions, and is a welcome response to the projected shortage of physicians in the coming years."
While those statistics apply only to MD schools, on the March 21, 2023 informational article on tiberhealth.com, "There are very few podiatry schools. According to the American Association of Colleges of Podiatric Medicine (AACPM), there are only 11 DPM programs in the U.S. as of 2023. As a result, the overall number of applicants is lower than those who apply to MD programs. The AACPM reports that there were just 910 applicants to DPM programs in 2021, a tiny fraction of the 62,443 people who applied to MD programs that year."
So, it still begs the question to ask what is our profession, the APMA, and all of the other podiatric professional organizations doing to increase awareness to the public, colleges, and universities on the career of podiatric medicine and surgery in order to increase the number of applicants?
Narmo L. Ortiz, Jr., DPM, Davenport, FL
02/13/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 D
From: Philip Radovic, DPM
It's unlikely any of our organizations will take action to neutralize misleading practices by establishments like the Good Feet Store. It's not sensible for any legitimate podiatrist to support their methods. We all know that many patients with generic foot issues can benefit from over-the-counter inserts costing less than $100. Over 30 years ago, when I was a new delegate to the CPMA, I proposed a resolution to tackle this issue, which received support from the then-presidents of both CPMA and APMA. Both of them visited a local store to investigate and reported that the staff was essentially practicing medicine without a license, in their opinion.
The store’s marketing at that time included claims disparaging traditional orthotics from podiatrists. They may still. At the Western CPMA conference, where I had proposed the resolution, I was astonished to see a Good Feet booth and a sign-up sheet for potential franchisees, attracting interest from many notable figures. The resolution ultimately did not lead to any action. I suspect quite a few “influential” podiatrists might be investors or franchisees in such stores or have some financial relationship. It is doubtful that our Associations would intervene in this matter, so we need to be vigilant and address such deceptive practices and questionable opinions in our professional and patient interactions as well as platforms like this one.
Philip Radovic, DPM, San Clemente, CA
02/13/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Rod Tomczak, DPM, MD, EdD
As much as we all know that The Good Feet Store (TGFS) is practicing podiatry without a license, it is difficult to do anything about TGFS. Complaints to the podiatry board or medical board often fall on deaf ears. The boards have no influence over TGFS since boards only intervene with licensed professionals. One might accuse TGFS with practicing podiatry without a license but the podiatry board is essentially impotent.
Practicing podiatry or medicine without a license comes under the aegis of the law enforcement branch of the government after a board determines the law was broken. Hence, the police or sheriff would have to arrest the owner of the store or the dispenser of the orthotic for practicing medicine, go through a legal process, and issue a fine or short jail term for a first offense. Actually, I defer to the DPM/JDs in the profession to correct me, but this is what I've been told is the process in most states. Pushing readymade orthotics doesn't really endanger the public like practicing plastic surgery without a license and is not worth the legal effort.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
02/13/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: James Koon, DPM
In response to a recent letter reflecting how much the Good Feet Store charges for inserts, it is my experience that they now charge about $1,500 for three different sets of pre-fabricated inserts matched to the patient after performing their manner of examination. Each pair is purported to be for a specific reason/activity/purpose.
On occasion, I will have a patient who has been in my practice for years show up one day complaining of continued heel/foot pain after having gone there and gotten these inserts with no improvement. I quit asking why they didn't come to me first, because what's done is done. Most of the time, the story goes that they developed the foot pain for which they got the inserts and went there because they thought they would help. And they must help an awful lot of people because there are franchise stores...
Editor's note: Dr. Koon's extended-length letter can be read here.
02/12/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Howard Bonenberger, DPM, Ivar E. Roth DPM, MPH
In response to patients who had similar problems with GFS inserts, I would write on an Rx pad "The devices (I never called them anything else) were not appropriate for the person's foot/ankle structure or their diagnosis. Please promptly provide a full refund. It always worked. Patients loved it, and they had me mold true Rx orthotics. Good for them and good for my practice.
Howard Bonenberger, DPM, Hollis, NH
My esteemed colleague asks how does Good Feet get away with charging $2,000 for an over-the-counter insert and some top covers. The answer is that they advertise and have salespeople work for them. Also, in general, the devices they sell work quite well. I am a big believer of supporting the arch maximally with an orthotic and the ones they sell do that. My patients LOVE the orthotics I make them and as I have said before are willing to pay a reasonable price for them... $850 for the first pair. I give a $200 discount on second pairs. I have a unique way I present orthotics to patients with which I have a 25% acceptance rate because they “get it”.
Ivar E. Roth DPM, MPH, Newport Beach, CA
02/08/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Allen Jacobs, DPM
Dr. Kravitz is making reference to what is generally termed the technological imperative, a concept first elucidated by Victor Fuchs in his textbook Economics and Policy. The technological imperative generally refers to an inclination to utilize a technology that has the potential for some benefit, however marginal or unsubstantiated that potential is. It is fueled by an abiding fascination with technology, the general expectation that newer is better, and unfortunately, at times, there are financial or other professional incentives driving the use of relatively unproven technologies. It is driven at times by what Sir William Osler, over 100 years ago, referred to as “pseudoscience”.
Podiatry like medicine in general, is an industry-dominated profession. We rely on industry for the medications we utilize to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
This topic is now temporarily closed.
02/08/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
RE: New PSSD Diagnostic Device
From: James Wilton, DPM
I have to read with some amusement this continuing line of thinking about the PSSD machine. I think a little education of the podiatric profession may be in line here. Two-point discrimination, which is what the PSSD machine does, was originally developed in the plastic surgery world for complex nerve repair, starting with battle wounds in the Second World War. Dr. Lee Dellon of Johns Hopkins University further developed the technology to look at what pressure threshold would be needed to determine two-point discrimination and also moving two-point discrimination, which are both significant diagnostic tools in looking at nerve regeneration. Two-point discrimination looks at nerve density and the innervation density of a particular area of skin that you are testing.
The brilliance of the PSSD technology is especially utilized in complex nerve repair cases where you are looking at re-innervation or in complex re-implantation procedures of arms, fingers, or toes. For basic screening for diabetic peripheral neuropathy, the hands-on clinical neurologic examination is the gold standard, utilizing hot and cold, vibratory thresholds, sharp and dull perception, and monofilament testing. As a screening tool, two-point discrimination is an excellent test using a wheel, and this is much more sensitive than monofilament testing. I hope this information adds some insight into this interesting thread.
James Wilton, DPM, Claremont, NH
02/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Philip Radovic, DPM
I would like to acknowledge Heather Kaufman, DPM and Richard Manolian, DPM for their professional integrity in addressing concerns related to recent PM News posts. Their decision to voice these concerns demonstrates a commitment to upholding ethical standards within the podiatry community. It has come to my attention that certain podiatrists' representations of themselves as mentors and authorities in the field have raised significant concerns among peers.
Please note that this message is intended to encourage professional dialogue and should not be interpreted as a definitive statement on the conduct or practices of any individual. It is merely an acknowledgment of the ongoing conversations within our community and a call for continued commitment to excellence in our field. The method of loss leader bilking of patients is unseemly, if not fraudulent. A podiatrist's portrayal as a sole gatekeeper for podiatric privileges in local hospitals, based on the claim of being the only podiatrist with a three-year residency, has been a subject of contention. These representations impact the professional advancement of other podiatrists and bring into question the integrity of such actions.
The hyper-promotion of a surgical procedure, advertised extensively in the newspapers as a universal “orthotic solution” for all ages, leads to considerable professional scrutiny. A lack of understanding of adjunct procedures can lead to post-interventions by orthopedists and podiatrists, ultimately resulting in the procedure being excluded from local hospitals. Again, this brings our profession into scrutiny. These situations highlight the importance of professional integrity and evidence-based practice and the ethical responsibility of medical professionals to prioritize patient welfare over personal or professional gain.
Philip Radovic, DPM, San Clemente, CA
02/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Jack Ressler, DPM
The last response to the query by Heather Kaufman, DPM was quite the character assassination of Ivar Roth, DPM. The thoughts expressed by Dr. Kaufman, "The hypocrisy and arrogance that drips from every word of his posts like slime down a wall is nauseating" was off base and extreme. Although on the surface, Dr. Roth's treatment plan of turning a $125 debridement service into a $3,000 plus visit seems extreme, I'm assuming a detailed treatment plan to address the patients fungal nail condition is incorporating medication and probably the use of a series of laser treatments.
The bottom line is that his patients are paying cash. I'm sure he gives his patients a detailed explanation of the course of treatment along with other options. Seeing that he is practicing in a liberal state like California, he is not holding the proverbial gun to his patients' heads forcing them into their decisions. I am sure Dr. Kaufman is an asset to the podiatric community. Going off on a fellow podiatrist like she did is not helping our profession.
Jack Ressler, DPM, Boca Raton, FL
02/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Howard Bonenberger, DPM
I wonder about the remaining 13% of patients with peripheral neurological involvement who ostensibly go undiagnosed or with a delayed diagnosis. What is the cost to them in time, advanced imaging, neurological consults, EMG, and potential degeneration of their health?
Do practitiners fret about recommending orthotics even when the patient must pay out-of-pocket? If not, is it because we believe that we are giving them our best advice? It is unfortunate that the discussion of abuse rises to the top in more than a few podiatry conversations.
Howard Bonenberger, DPM, Hollis, NH
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