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12/04/2015
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Medicaid's Law of Diminishing Returns
From: Andrew Gegerson, DPM
I received an email from Medicaid informing me that Medicaid will no longer cover the co-insurance for their Medicare/Medicaid clients. When I questioned the representative, she said that Medicaid will only pay if the Medicare billed amount is less than Medicaid's allowable charge. If Medicare's paid amount is greater than Medicaid, Medicaid will consider the bill paid and reimburse nothing. When did they decide that? When did we decide to work for 20% less? It was bad enough when they insulted us with 20% of the 20%, now we don't even get that. Oh and by the way, we can't bill the patient.
Andrew Gegerson, DPM, Brooklyn, 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.
06/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1B
From: Ivar E. Roth, DPM, MPH
Kudos to Drs. Tomczak and now Saxena. I have written this in PM News before without any evidence, but as told to me from my son who recently graduated. He said a good number of students in his class should never have been allowed to be accepted in the first place. A fair number dropped out after the first and second year, but he felt that there were many in his class that just graduated who were barely hanging on and probably should have been weeded out.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
06/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1
From: Amol Saxena, DPM, MPH
Mic drop for Dr. Tomczak! Makes me think of the Jack Nicholson line, "You can’t handle the truth." Promoting podiatry is one thing and lowering standards to fill seats is another. Kudos to him for doing the research and pointing out the current data available.
Amol Saxena, DPM, MPH, Palo Alo, CA
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 2
From: Alan Sherman, DPM
It is gratifying to see the last two messages from Drs. Pressman and Tomczak supporting the need for some kind of dual track 3-year residency training program to best meet the training needs of both predominantly surgical and medically oriented podiatrists. We are all proud of what our profession has accomplished in the development of the standardized 3-year surgical residency model. It seems to be producing excellent foot surgeons that are well respected in medical delivery systems, well employed, and well rewarded financially. But these two individuals seem to agree with me that it is time to catch our breath and assess whether these training programs are the best that we can do in training ALL the podiatrists that the U.S. population needs to provide for their foot care needs in the decades ahead.
My main concern is that a resident’s time is well spent training in the work that they will be doing after their 3 years are up. Believe me, I know that restructuring what was years in the making will be difficult. But perhaps some programs are already well suited to offer more clinic-based outpatient training for residents heading for more medically oriented office-based practice? And where does wound care, which occupies so much of podiatry practice, fall in this dual track system? I’d like to hear opinions of other PM News readers.
Alan Sherman, DPM, Boca Raton, FL
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 2
From: Alan Sherman, DPM
Dr. Jacobs has somehow gotten the impression that someone is arguing for less than 3 years of residency training for podiatrists, so he continues to argue that we need 3 years of training. I don't know how he has gotten the impression that any of us want to reduce the length of residency training. I have not seen anyone express that opinion and I have certainly not expressed it. He is arguing, strongly, against no one. And he regales us with an, admittedly, heroic recounting of his treating a life-threatening necrotizing fasciitis and making sophisticated decisions regarding IT. Good for him. I admire him. But how many podiatrists or for that matter, MDs/DOs want that kind of practice?
Most podiatrists would gladly refer that patient to him or the other minority of DPMs or MDs/DOs who want to treat that high risk, critically ill patient. We speak in this forum about the danger of prospective students reading negative opinions and criticism about the profession. But what do you think is the impact on that student with reading that treating this type of patient is what they will be doing as a podiatrist? How does that affect their inclination to apply to podiatry school? My opinion is that we need a few heroic foot surgeons like Dr. Jacobs in each community who do these types of cases, with the rest referring those cases to them. All DPMs need not be created in his image. We need a variety of podiatrists to treat the cross-section of patients who see podiatrists, and their training should be appropriate for what they actually do treat.
Alan Sherman, DPM, Boca Raton, FL
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.
05/29/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Do We Really Have a Medical Degree (Allen M. Jacobs, DPM)
From: Gary S Smith, DPM
I agree with Dr. Jacobs that a 3-year residency can make a huge difference in surgical skills. The problem is that according to PM News surveys, the majority of podiatrists don't do ORIF of ankle fractures and don't want to. Many people go into podiatry to practice podiatric medicine and not orthopedic surgery. This is no longer an option to them. With the mandatory 3-year program, it's just not logical to do the same time in training of MDs and DOs with unlimited specialty options when podiatrists only have one.
The 3-year residency, once a premiere program ensuring excellence in training is now like a high school diploma. Everybody has one. I have seen 3-year graduates who could not do a hammertoe arthroplasty or even a matrixectomy with competence. I would also like to point out that because of this generic requirement, podiatrists like Dr. Jacobs cannot get privileges at many hospitals today.
Gary S Smith, DPM, Bradford, PA
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 3 B
From: H. David Gottlieb, DPM, Ivar E. Roth, DPM, MPH
Dr. Hultman hits the nail on the head. The MD degree does nothing for anyone unless they are going into pure research. What matters is one's license. That determines what one can do. Fight for the plenary license with our current education and training, not another degree.
H. David Gottlieb, DPM, Baltimore, MD
I agree with Dr. Hultman's solution that a plenary medical license could very well work for our profession, but I also know that these discussions have gone on for over a decade and from what I can see, nothing has happened here in California. I would appreciate hearing more from Dr. Hultman on what it would take and when he thinks this could really happen. The time is now and the profession needs this upgrade now, so please tell us what needs to happen.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
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