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12/26/2014
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Who Gets Our Money?
From: Jeffrey Kass, DPM
Who, if anyone, gets monies deducted from their income from sequestration? Do politicians get monies deducted from their salary? Are we having money deducted from our income because these bafoons in Congress cannot come to a compromise regarding the deficit? So, in other words, they are not doing their job and we suffer financially? Why is it that I am constantly reading about members of Congress getting raises? Why aren't their salaries frozen like ours are with the Medicare SGR?
Why is it that members of the medical community are allowing sequestration cuts, penalties for this and that...what other profession gets hit with monetary deductions in pay like this? The podiatric community should seriously consider hiring a social activist to help us, as we are too busy getting pre-authorizations to find the time to complain about these issues. New Yorkers don't like hearing or seeing Rev. Al Sharpton too much, but the bottom line is he is a voice that is listened to because he represents a minority people. The medical landscape is changing and we need a "Rev. Al Sharpton" type of activist to help support our causes.
Jeffrey Kass, DPM, Forest Hills, NY
Other messages in this thread:
06/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: James DiResta, DPM, MPH
While I don't disagree with the need for podiatry to visit more colleges to gain more exposure to potential applicants, I am more concerned about the watering down of our applicants' strength to schools of podiatric medicine. The problem as we have stated over and over is how can we possibly get enough qualified students is this diminishing pool. Schools of osteopathic medicine are growing exponentially. For example, have you ever heard of Debusk College of Osteopathic Medicine? It has two schools in Tennessee now and a third opening in Florida in 2026. Did you know MSU has three campuses now of osteopathic medical students. How about Meritus School of Osteopathic Medicine in Maryland? How about The Edward Via College of Osteopathic Medicine (VCOM) now in four campuses!
There are 43 osteopathic schools listed but in reality there are presently 69 campuses and many more coming. The mean MCAT of all their schools for 2024 is 502.43 and falling. Several of the schools are below...
Editor's note: Dr. DiResta's extended-length letter can be read here.
06/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Other Non-MD, Non-DO Doctor Healthcare Providers
From: Rod Tomczak, DPM, MD, EdD
I thought it might be interesting to look at the data surrounding other non-physicians, but in a non-judgmental view, of course. Draw your own conclusions but be sure to refrain from rash judging anyone blowing their own horn about how hard they work and the good they do. A lot of the following data had large ranges, so I used the Jethro Bodine average technique. For those who aren’t familiar with Jethro, it went something like; “Cipher, carry, naught, naught, carry, cipher, etc…”
Doctors of Chiropractic
There are 18 accredited chiropractic colleges in the U.S. with 2,800 first year students right now. In 2023, approximately 2,700 students were awarded a Doctor of Chiropractic degree. Tuition per year averages about $30,000 and the average income is $89,000 per year. Average admission GPA is 3.38 and a school can suffer loss of accreditation if they admit anyone with a GPA below 3.0. Most accredited chiropractic schools offer...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Compensating for Podiatric Surgeons Who are Not Trained In General Podiatry
From Elliot Udell, DPM
There has been a great deal of discussion on how to compensate for a lack of training in general podiatry at some of our 3-year residency programs. The issue is that many who complete these programs are masters in foot and ankle surgery but are not trained in how to manage patients with "corns, calluses, warts, ingrown toenails, and other "bread & butter" pathologies.
When I did my residency many years ago, we treated patients at a hospital-based general podiatry clinic several days a week, managed all foot emergencies in the ER, and assisted podiatric surgeons and orthopedic surgeons in the operating room. Many programs today, as has been well pointed out, are strong in surgical training but lacking in general podiatry training. The root of the problem may be that these programs may not have standing general podiatry clinics. If that is the case, these programs can work with general podiatrists and have residents rotate through their offices in order to master the non-surgical aspects of our profession.
Elliot Udell, DPM, Hicksville, NY
06/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Martin M Pressman, DPM
Thank you, Dr. Tomzack for not burying me. I do remember my trip to Ohio State to review your program. Things have indeed changed and evolution continues in spite of the inertia. In the last PM News, there was an interesting article by Jarrod Shapiro, DPM about surgical vs non-surgical podiatry. The article is apropos to the issue at hand. As I see it, the unified 3-year residency has brought podiatry to parity with medicine with respect to post-graduate training hours. Of course this is not the solution to all issues with respect to the profession's duality (medicine vs surgery). Medicine struggled with this issue when GI docs started endoscopy and cardiologists and radiologists became interventionalists.
Somehow they solved the issues between cardiac surgeons, vascular surgeons, and general surgeons and their respective medical colleagues. Disparate training algorithms, yet somehow they work together. I saw that at Yale for 25 years. I do not have a solution for this profession's problems, but I am sure that solutions exist. Perhaps the 3-year training model can have a medical model leading to an optional approved foot surgery fellowship for those PM trained DPMs who want or need to do surgery. The surgery done in the podiatric medical model plus a one year fellowship perhaps could lead to ABFAS foot surgery certification. There is an answer that could satisfy all parties involved. This probably will not stop the turf battles that seem incurable within medicine and podiatry. The answer is NOT to allow our medicine board to certify in surgery!
Martin M Pressman, DPM, Summerville, SC
06/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Martin M Pressman, DPM
Dr. Kesselman asks why podiatry was “not even listed” in the AMA article on scope creep of lesser trained (post graduate hours/residency) providers. The article does not mention podiatry for good reasons. Our training hours are consistent with most MD and DO post-graduate programs. I have been part of the “parity movement” for all of my 50-year professional career. I have seen the AMA/Orthopedic partnership fight every advance podiatry has made and call it the derogatory term “scope creep”. This article was based on measuring competence and patient safety on hours of post-graduate training. (Pedagogically sound?) In all comparisons, the article stresses the lack of training hours for the professions listed. The fact that podiatry was not on the list is simply because our training has reached “parity”.
Of course, the AMA article does say one must go to an MD/DO medical school to be a physician. I am also fairly certain no orthopedic input was sought by the author or we would have somehow been number one on the list. In the end, not being on this list or even mentioned in an AMA article on scope creep is, in my view, a reluctant acceptance of our training model.
Martin M Pressman, DPM, Summerville, SC
06/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Rod Tomczak. DPM, MD, EdD
I would like to comment on the letter by Martin Pressman, DPM. In the spirit of true transparency which I insist upon, Dr. Pressman was one of my trainers at Metropolitan Hospital in Philadelphia where I completed a two-year residency beginning in 1977. I am neither afraid to bury or praise podiatrists who have influenced my life.
When I arrived at Ohio State University from Des Moines CPM in 1995, there were two foot and ankle care givers for the 35,000 faculty and staff plus their families who were self-insured by the University’s prime care, 55,000 students and outside patients. The two foot and ankle physicians were the chair of the department, Sheldon Simon, MD and myself. I asked him if I could start a surgical residency program shortly after arriving. He told me...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Paul Kessleman, DPM
I hope Dr. Pressman can answer a question or two about the reference AMA article. I agree that the three-year 4/4/3 model may have helped elevate us to the point where podiatry is no longer negatively noted in this interesting article. Unless I am missing something, however, I failed to see in the reference article any mention of podiatrists at all. The physicians who were listed were MDs, DOs, even optometrists and naturopathic physicians.
I guess the good news is that nothing was noted negatively about DPMs, but where does that leave us if we are not even listed? I am sure those of us who read the AMA article would appreciate some interpretative explanation for this. Or if I missed something, please let me know.
Paul Kesselman, DPM, Oceanside, NY
06/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry’s Greatest Generation
From: Rod Tomczak, DPM, MD, EdD
Several of us have written about the podiatrists who mentored us in podiatry, mostly guys who were unselfish with their knowledge and time. As Tom Brokaw wrote, they stopped the greatest threats to mankind and returned home without their comrades. When they spoke, we listened and many would not talk about what they had been through. My father was a medic attached to the Marines in the South Pacific hitting a number of beaches in the first wave. When he was a 19-year-old kid, he was deciding which 19-year-old kids were going to live and which ones were going to die on that beach. The only thing he told me was that on bloody battles like Guadalcanal, he took more cigarettes and morphine for the dying. He didn’t worry much about addiction on that beach. In return, the kids he didn’t know gave him letters to send home. That’s all he ever told me.
We respected and tried to emulate. They set us straight when we complained and we knew what was expected of us. I worked...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
05/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Barbara Hirsch, DPM
I do not think it is necessary to make hospital rounds or work in an OR to make a conclusion, voice an opinion, or make a suggestion on residency programs. Many practitioners are "non-practicing" in some manner. Does that mean they do not understand ways to move forward in our profession?
Dr. Sherman communicates with many podiatrists and has a broad base for understanding our profession. Not every medical student wants to do surgery. Perhaps not every podiatry student does either, and that should be taken into account. I realize Dr. Sherman's letter may not have a factual basis for each point, but he has provided input and suggestions that are valid.
Barbara Hirsch, DPM, Rockville, MD
05/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: James Hatfield, DPM
At the end of the day, I ask myself if I enjoy what I did in my practice - Yes. Was I as busy as I needed to be? - Yes - I was booked up for 2 months ahead. Did I make a good living? - Yes - equivalent with most of the physicians in the area. Did I need to do better? – No. Did I have good privileges at the local hospital - Yes, full scope available. Did I do my own H&Ps – Yes. Did I get referrals from the local MDs? - Yes, lots. Did the MDs call me "Doctor"? – Yes. Did the patients call me "Doctor”?- Yes.
Anyone who needs more than this has an inferiority complex. Podiatry is consistently rated as one of the highest paying jobs in the U.S: #19th by U.S. News & World Report: Any student who can't be happy considering podiatry as a career is foolish.
James Hatfield, DPM, Encinitas, CA
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Allen M. Jacobs, DPM
On what factual basis does Dr. Sherman suggest that the 3-year surgical residency model has negatively impacted on podiatric colleges application pools? He is and has been a non-practicing podiatrist for many years. When did he last make hospital rounds with students/residents or work in an OR with students/residents? Would he be so kind as to share with us the substantive FACTS for his predicate please.
While we all appreciate his philosophy as a non-practicing clinician, legitimate and reliable data, not philosophy, should form the basis upon which to conclude that the current residency model requires serious modification. For many years, the various residency models (medicine, surgery, 1, 2, or 3 years) created uncertainty and the suggestion of lack of uniform training in podiatry among our medical colleagues. In addition, multi-level changes in the evaluation and certification of residencies would be necessary.
Allen M. Jacobs, DPM, St. Louis, MO
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Paul Kesselman, DPM
I too, like Arden Smith, am retired from clinical practice, but during my clinical days, my office waiting room, like Arden's, was always full. Most of the MD/DO in my area were not only respectful of my degree, but they worked with me in the hospitals, referred their private patients to me, and many MDs/DOs became my patients.
One internist who was locally famous had to sneak in at the end of the day so as to avoid him having to sit in the waiting room with many of his patients. After a few such visits, I suggested we needed to figure out a way to stop these no charge visits to him in my reception area. My office waiting room could not be used as his POS. But initially I said no, he had to sit in my waiting room so he could see what it was not only like to see how it feels to be a patient, but I wanted him to experience the full breath of what podiatrists treat. And believe me he learned...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Allen M. Jacobs, DPM
Arden Smith reminds those of us from Philadelphia of his appreciation of Louis Newman and "Buzz" Forman. Both of these were also mentors of mine. When I was working in the OR at Kensington Hospital in Philadelphia, I was fascinated watching Dr. Forman teach podiatry students on clinical rounds. He went on and on questioning and educating the students. He was not a paid faculty member of the college. If I recall correctly, he was one of the first ACFAS members with a very low number on his certificate. He was devoting his time to advancing our profession with no financial award. I was very young working as a patient transporter from the room to OR and back. I remember how shocked I was watching him remove 10 toenails, thinking OMG! I watched him do forefoot surgery, always teaching. That is how you advance a profession.
Louis Newman was a dedicated surgical educator. I worked with him at Oxford Hospital and Rolling Hill Hospital in Philadelphia. He would take the students to lunch, educate us over a meal, direct and build our skills in the OR, then spend time with us after cases...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
05/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Arden Smith, DPM
Maybe I am overly simplistic, or maybe I’m just old! But, if you open up a foot, move the bones around as needed, put it all back together again, that sounds like a doctor to me; and also to everyone that I know, including other medical professionals. If you heal a nasty wound that’s been around for a long time and possibly save a limb, that sounds like a doctor to me; and also to everybody that I know, Including other medical professionals.
On the flipside, if you have a busy office full of patients that love you, because you make them feel better, that sure sounds like a doctor to me; and also, to everyone I know, including other medical professionals. I can understand the fixation on the degree, but it’s time to either get over it, or to somehow try to fix it. I hope that...
Editor's note: Dr. Smith's extended-length letter can be read here.
05/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Alan Sherman, DPM
I agree with my good friend Dr. Reingold that, certainly, we are regarded as doctors by our patients and the medical community but disagree with him strongly on one point that he makes. Putting all podiatry students through a 3-year surgical residency is resulting in 3 major problems for us: (1) it is directly reducing the application pool to podiatry schools, and (2) it is wasting the time of the majority of podiatrists in training who are not suited to be advanced surgeons, and (3) it is resulting in those who will be foot and ankle surgeons having less cases to train on. I am not advocating for shortening residency training for any podiatrists. We must never reduce residency training to less than 3 years.
What I am advocating for is to stratify residency training, to have a "sorting" process after the first year, when it's clear who is suited to be an advanced surgeon, and who is better suited to do wound care and general podiatry. Over time, we will get more applications to podiatry schools by the many who know that they don't wish to be surgeons, but do want to be great general practice foot doctors.
Alan Sherman, DPM, Boca Raton, FL
05/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jeffrey Trantalis, DPM
It is difficult to have a profession when you can go to your local store and get orthotics. Seeing ads for Good Feet orthotics is not going to strengthen our profession.
Jeffrey Trantalis, DPM, (Retired), Delray Beach, FL
05/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jack Reingold, DPM
After reading dozens of viewpoints on the subject, I thought I would add mine. First of all, we are doctors. I’ve never had a patient in my 40 years of practice question whether or not I was a doctor or even realize what degree I hold. I graduated in 1979 and had the privilege of being residency trained. I had the ability to change the guidelines at three hospitals and added ankle privileges to all. At the last hospital, I sat on the orthopedic committee and said that I thought we should be judged by the same standards as any surgeon and there were no complaints. I noticed that in the orthopedic guidelines, they had one check off box for ankle, so I did the same (note, the applicant had to show competency.). The guidelines were passed without discussion!
Most of our residents are very well trained in foot and ankle pathology. Whether they choose to practice in the surgical arena or not is their choice. There are many orthopedists who have completed surgical residencies but choose areas where they are not in the OR. This is true of other specialties also. I believe that our residencies should train us all to be surgeons, but there should be fellowships for those who wish to excel in one specific area.
Those of us who had less than three years of residency will disappear with time. The three-year residency will be the standard, plus fellowships for many. In summary, we should all have training in all areas of pathology, and all of our residents should have the ability to practice in the direction they wish to go.
Jack Reingold, DPM, Solana Beach, CA
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
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Intoxicated with Podiatry
From: Rod Tomczak, DPM, MD, EdD
I have been looking at the periodicals published by the schools which I view as grand advertising campaigns. Of course, we highlight the accomplishments of recent graduates costumed in their not green any more greens. The central part of the picture is usually the terms “foot and ankle surgeon” and the text emphasizes how grateful he or she is to the school even though we know the residency program is really the tool responsible for later accomplishments. As of late, there are headlines bragging about the 100% residency placement. That may impress some 70 something year-old podiatrists who reminisce how difficult it was to get a residency. These septuagenarians don’t know there are currently more residencies than graduates.
It might be more reflective of a school’s success in resident placement if the headline read, “93% of Best Medical College of Podiatric Medicine are Placed in their First Choice of Podiatric Residency,” when there are only 24 graduates. This good press is at least remotely intended to bolster the ...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
RE: Do We Really Have a Medical Degree? (Gary S. Smith, DPM)
From: Rod Tomczak, DPM, MD, EdD
I appreciate Dr. Smith's admission that he has never heard of a broken screw extractor set. As Clint Eastwood said, "A man's got to know his limitations." Directions on how to use the many different types are readily available on reputable surgical sites such as Facebook, YouTube, and others offering "how to videos." Original internal fixation screws were not always made of the best materials like they are today. So, if a patient had a a painful, broken screw, they often wanted it extracted. So, the consent form usually read, "extraction of painful internal fixation device." It would be a real disappointment to the patient if it had to be left in the foot or ankle and the patient referred to someone more familiar with the instrumentation.
Sometimes things get left in the patient and they shouldn't be. When Woody Hayes had his gall bladder removed, a sponge was left in his abdomen and had to be removed the next day. Rumor has it the surgeon came from Michigan and the first assistant from Pennsylvania. I wonder if McGlamry, Mann, and Meyerson were too busy to operate or write textbooks or articles. In order to save them time, the ICD and CPT codes are ICD-10 84.293 and CPT 20680 for a painful internal fixation device and its removal.
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
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
From: Farshid Nejad, DPM
I have heard Dr. Kesselman voice his concerns on how physicians are being manhandled by insurers, including Medicare. Medicine has been complacent about standing up for our rights to be autonomous and getting reimbursed fairly. Know that this complacency has led to the momentum to silence us completely by creating so many regulatory requirements and, more importantly, financially stifling us to weaken our monetary ability to lobby. When we cannot afford to support ourselves, let alone our national associations, we will have very few options to fight. WE HOLD ALL THE CARDS, yet we do not know how to play them.
We need to ask for a raise, we need to stop MIPS reporting penalties, we need to create reciprocal and equal rules for audits and look backs (if we get one year to bill, Medicare should only get one year to audit), we need to remove the pay difference in POS 31 vs POS 32 in SNFs. These injustices are just the tip of the iceberg of the laundry list of issues that REQUIRE CHANGE. This affects all physicians, not just podiatrists. We need our associations to contact the news networks to publicize these issues (free advertisement). THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
Farshid Nejad, DPM, Beverly Hills, CA
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Gary S. Smith, DPM
I think Dr. Tonczak's letter perfectly defines the conflict between academics and practical podiatrists. I was doing some training at the Pittsburgh Podiatry Hospital when I asked the most prolific surgeon why he didn't write books and articles. He answered, "because I don't have time."
Dr. Tomczak said not knowing about a screw extractor should disqualify board certification. I was the director of a surgical residency and didn't know about them. No hospital I ever worked in would have such an instrument in stock. Maybe breaking a screw during surgery and not being able to deal with it should disqualify you from certification?
Gary S Smith, DPM, Bradford, PA
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