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04/22/2019
RESPONSES/COMMENTS (NON-CLINICAL)
From: Michael Schneider, DPM
Keep your license at least for a few years. You never know what may come your way.
Michael Schneider, DPM, Denver, CO
Other messages in this thread:
09/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Increased Risk of Fatal Falls
From: Paul Kesselman, DPM
A recent article in September 7, 2025 NY Times entitled "Why Are More Older People Dying After Falls," is a must read for every physician, no matter their specialty. The NY Times article points out a three-fold increase in fatal falls over the last thirty years. This compared to adecreased or steady number of fatal falls per capita in other countries.
The reason cited by both the NY Times and its source is the increased reliance on Fall Risk Increased Drugs (FRID) in the U.S. JAMA News while a much lengthier read, provides a substantial amount of statistical analysis and is the foundation of the findings cited in the NY Times article..
Having no other motive but to decrease falls in our most fragile patients, it is imperative to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Keith L. Gurnick, DPM
Frustrating as it may be, there are still some medical specialists who are so full of themselves that they feel comfortable giving patients miss information on topics where they have little expertise nor experience. In the world of custom prescription foot orthotics this is also commonplace. Trying to educate these "experts in everything" is a noble effort, but I prefer to pick and choose my battles and fight the battles I know I can win. I would rather spend my time educating my patients, than educating the doctor who probably made a quick off-the-cuff remark anyway.
Patient education should have been done in advance, not retroactively when the concern or complaint was presented. Regarding a refund. If a patient wants their money returned, the reason is inconsequential. I would give the money back, it happens so infrequently it does not matter. If the orthotics have already been dispensed, I would first get the orthotics back, and if they have not been made, I would cancel the order, and if they have been made but not dispensed, I would pay the lab fee and I now have a brand new unused set of orthotics to show the next patient what a custom prescription foot orthotics looks like.
Keith L. Gurnick, DPM, Los Angeles, CA
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1D
From: Burton J. Katzen, DPM
When I was in practice and was confronted with this problem comparing orthotics/Hyprocure to store bought arch supports, I would try to educate the patient in layman's terms the difference between pronation and simple flattening of the arch, telling the patient that the majority of the problem was not the height of the arch, but the amount of abnormal motion that occurred when the foot beared weight.
I would demonstrate this by forcefully "shoving" my fist into the patient's arch and showing that I could still easily pronate/evert, or in their words, "flatten" the foot from the sub-talar joint, imitating what an arch support did. I would then lock in the heel with just my thumb to show that I could no longer pronate the foot to demonstrate the difference in control.
I also would never knock a store-bought orthotic telling the patient that, "Hey, The reason Dr. Scholl was rich is because store-bought arch supports do work for many people just like store-bought readers do work for some patients, but other patients need professional care." Also, in my experience, most of the patients I came into contact with had already tried the store bought orthotics.
Burton J. Katzen, DPM (Retired), West Pam Beach, FL
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: David S. Wolf, DPM
I can understand your frustration—and fortunately not very common. When I was in practice, I would have taken the high road in these situations and re-focus the conversation on patient education. I explained the purpose of the custom orthotics, the biomechanics involved, and why we recommended them based on their specific foot structure and pathology.
If they’re still not receptive and demanding, I would make a refund. For every one non-compliant patient, there were too many to count compliant patients. Ultimately—is the time, energy, and potential negative review worth the fee? And most importantly, I wouldn't let one orthopedist's opinion shake your confidence in the value of what we do.
Sometimes, it’s just better to give a refund and move on to the next treatment room. Say to yourself before you walk in, "It's showtime"-and make that patient feel like they are the only patient you have. Patients don't care what you know, they just want to know that you care (Bernie Hirsch, of blessed memory).
David S. Wolf, DPM, retired
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Dieter J Fellner, DPM, Ivar E. Roth, DPM, MPH
Custom orthoses cost hundreds more than OTC devices, and current evidence shows they don’t correct bunion deformity and are not superior to pre-fabs for most common foot pain. However, that doesn’t make them “bogus.” Orthoses can reduce pain and plantar loading, and custom devices are appropriate for patients with complex foot structure or failed OTC trials. For early bunions with over-pronation, they won’t reverse the deformity, but they can reduce symptoms and mechanical stress—which is a valid treatment goal. Our job is simply to match the level of support to the patient’s needs, not to oversell either option.
I guess the question, then, is what unique biomechanical findings does the patient have, to warrant the added expenditure?
Dieter J Fellner, DPM, NY, NY
I would call up the orthopedist and make an appointment to go speak to him. Here is a way to turn a lemon into lemonade. In this meeting, explain what you are doing and why it is preferred to an OTC insole. Hopefully, you can get him to send to you all of his foot patients who need orthotics. It is certainly worth the effort in my opinion. Or make a pair for him gratis. I recently made a pair for an orthopedist in town, and now he sends me ALL his orthotics that he was sending to Hanger.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Carl Solomon, DPM, Bret Ribotsky,, DPM
My response has always been that custom orthotics vs. off-the-shelf are akin to prescription eyeglasses vs. "readers' purchased at the drug store. I told patients that it probably wouldn't hurt to try the OTCs and occasionally with a little luck, they may help some. But although there are no guarantees, the custom orthotics (like prescription eyeglasses) are more likely to be effective since they are custom-fabricated to address a specific problem. In actual practice, it hasn't really happened but If a dissatisfied patient elects to change their mind and cancel them before lab fees are incurred, I suppose I'd give them a refund. Otherwise, if based upon someone else's criticism alone, I would not.
Carl Solomon, DPM, Retired, Dallas, TX
This is an incredible opportunity to turn lemons into Limoncello. I dealt with this often when I first started practicing a long, long time ago. What I would always do is call the orthopedics office, set up an appointment to either meet him for breakfast or dinner, and spend the time to show him how custom biomechanical orthotics can reduce the pain in a patient’s knees and prolong his knee replacements and hip replacement by realigning the forces. Every time I did this, I was able to generate an additional 20 to 50 pairs of orthotics a year from each orthopedist.
Bret Ribotsky, DPM, Fort Lauderdale, FL
09/02/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The Bagel Theory of Office Visit Pricing
From: Al Musella, DPM
One of my favorite teachers, the late Jules Shangold, back at NYCPM in the early 1980s used to tell us he set his office visit price at 100 times the cost of a bagel. At the time, a bagel was 15 cents so his office visit was $15. Today, I purchased a bagel for $5. So should we be charging $500 per visit?
Al Musella, DPM, Hewlett, NY
08/26/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Podiatric Groundhog Day
From: Rod Tomczak, DPM, MD, EdD
I came across the book The Evolution of a Profession: The First 75 Years of the American College of Foot and Ankle Surgeons, written by historian Kenneth Durr, PhD with Jerome S. Noll, DPM, EdD. It can be downloaded here as a .PDF.
I suggest that everyone concerned about the growth pains podiatry is experiencing read the salient parts of the 180 page book (first 90 pages) to come to the conclusion that as we grow, we keep getting in our own way, stumbling over our own feet, and continue to be jealous of those that have a little bit more. Except for our growth in podiatric knowledge and scientific/procedural advancements, we are right where we were in the 1950s and '60s. They argued about certification,...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/25/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Joel Lang, DPM
Many years ago, when I first came under the tutelage of Dr. Charlie Turchin, one of the first things he taught was to remove all the springs from clippers and nippers. His reasoning was that you get a better precision and feel for the tissue you are cutting through without having to first overcome the resistance of the spring.
I admit that at first it seemed awkward and difficult and required a different grip on the instrument. My 4th finger became the spring. Once mastered, it did give me a better feel for the tissue. I never used a spring on an instrument for the remainder of my 32 years of practice. Try it!
Joel Lang, DPM, Retired, Cheverly, MD
08/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Dominic Bianco
While it may be more reasonable to change the springs in-house, it can be a daunting and dangerous task. Through my 50 years of providing quality service to podiatrists, I have probably changed and installed well over a million nail nippers springs. Things can happen. Screws can break, screwdrivers can cut your hand, especially a screwdriver that is thin enough to properly loosen and tighten the very small screws.
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Screwdriver injury |
Nail cutters are usually sharp; they can also cut you. I’ve been wounded by screwdrivers many times. This one being the worse case. We have thousands of springs and nipper screws in stock and we can also make custom size springs for any instrument, if needed.
Dominic Bianco, CEO Bianco Instruments LLC
08/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Keith Gurnick, DPM
In my office, I keep a small box filled with used, worn out or broken instrument spare parts, and screws from broken tissue nippers and nail trimmers with broken springs. Often, when a spring breaks on a tissue nipper or a toenail clipper, I can easily replace the broken part quickly and simply with a similar part that I saved, and am able to locate in the box. Otherwise, the broken instrument goes into the box, or into the trash, and I will purchase new ones.
However, if you have broken two out of four new nail nippers, either the quality of the nipper is poor (Pakistani stainless steel vs. German stainless steel) or you are using too small of a clipper on too thick a toenail, or you may be heavy-handed or rushing, or you might just need a larger nail clipper, or you may need to "adjust" or "modify" your toenail clipping technique.
Keith Gurnick, DPM, Los Angeles, CA
08/11/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: How About Three Cheers for Podiatry?
From: Lawrence Rubin, DPM
Let's start patting ourselves on the back for choosing the profession of podiatry. What physician other than the podiatric physician has the opportunity virtually every day of clinical practice to use simple fishing line-type calibrated nylon filaments to check for undiagnosed and untreated diabetic peripheral neuropathy -- and by doing so, potentially prevent a limb from being amputated, and by this, increase that patient's life expectancy?
Three cheers for podiatry, please!
Lawrence Rubin, DPM, Las Vegas, NV
08/08/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Beware of Insurance Phishing Scam
From: Howard Dinowitz, DPM
i wanted to alert PM News to an issue I found in my email. I had it verified that it was a phishing scam. The letter statied that they need verification of a check from an insurance company with a stated amount and a bonafide insurance company that I have submitted claims to in the past.
It had the date of service, my TIN number, but it was lacking the patient's name. They wanted me to fill out the questionnaire to get a check sent to me. After searching through my EMR for 3 years of service, I discovered there was no such claim with that insurance company. The thought process was that this very well could have been from the Change healthcare fiasco. Let this serve as a warning to those receiving similar emails. It looked too good and it was.
Howard Dinowitz, DPM, Brooklyn, NY
08/06/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: DPM, Nurse Practitioner
From: Daniel Chaskin, DPM
Instead of getting an off-shore MD degree, why not work out an agreement with nursing schools so that a DPM might have advanced standing to get that NP degree in less time than a normal nursing student. This way, an unlimited license can be obtained with an NP degree without worrying about getting a residency match with a U.S. medical residency program.
With the DPM degree and NP degree, one can then apply for a podiatric residency program and treat all foot and leg problems without worrying about getting an ankle permit. After all, an NP is licensed to treat the entire body. My question is how many podiatrists obtained NP degrees or nursing degrees?
Daniel Chaskin, DPM, Ridgewood, NY
07/31/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
Thank you, Dr. DiResta, for pointing out the fact that APMA discontinued their sponsorship of the Dartmouth MPH program. I was totally unaware of that, but the fact remains that when it was in place, it provided graduates who went onto non-clinical careers or it simply improved those individual's status in whatever clinical programs they were involved with. Now that Becker's has published the story I wrote about where both MD and DO programs are offering dual programs for medicine and MPH or MBA, perhaps it is time that APMA reassess its importance. Perhaps APMA, if it cannot afford to sponsor this program itself, can partner with other private enterprises which have profited from podiatry well over the years to offer such scholarships to individuals interested in one of these programs.
I have been made aware for some time that APMA has serious financial issues. Having been a member of various committees over the years as well as...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/30/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: William Wayne Egelston, DPM
I too enjoy the posts in PM News. Whether one agrees with the authors or not, doesn't detract from their insightfulness. I appreciate the dialogue presented by Drs. Kesselman and DiResta and others on this topic. Considering how things are evolving for podiatrists with diminishing numbers of qualified (academically prepared) applicants, likelihood of schools (some or all) closing and increasing number of MD/DO schools on the horizon. It would seem to me a likely scenario might be that future applicants matriculate to MD/DO schools (domestic/foreign), complete orthopedic residencies and foot and ankle fellowships (or others), then train physician extenders (LVN, RN, NP, PA, etc.) in C&C, nail care, and primary podiatry. I see this as a more plausible pathway than watching our decline and obsolescence.
I see this as I, along with other DPMs at Kaiser (California), functioned in...
Editor's note: Dr. Egelston's extended-length letter can be read here.
07/30/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Dr. DiResta gets it! It's not because he mentions me or my ideas about the DO path to an unrestricted license but because of his observations concerning the DPM degree NOT being a starting point to move forward. It is a starting point to move laterally. You can have an MHA, MPH, or a PhD in healthcare, but try to aspirate a knee and see how far a master's degree gets you.
Get the DO degree, then enough ACGME-approved residency time to get an unrestricted license, followed by an APMA fellowship in podiatry from Temple, Touro, LECOM, DMU, or UTRGV. Now you can move forward from your starting point.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
07/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: AOFAS and Podiatry
From: Jeffrey Trantalis, DPM
The American Orthopaedic Foot & Ankle Society (AOFAS) was started in Chicago in 1969. The organization officially added “Ankle” to its name in 1983 to reflect a broader clinical and surgical focus. I was practicing in The State of Washington during this time. One of their goals was to put podiatrists out of business. The irony and sad part of all this is that some of the orthopedists were trained by a podiatrist at Harborview Hospital. Now they have their own institution teaching our profession to orthopedists. The bottle has been opened and now we are paying for it.
Jeffrey Trantalis, DPM, (Retired), Delray Beach, FL
07/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: James DiResta, DPM, MPH
I normally enjoy comments from Dr. Kesselman on the blog, but I do believe he has missed the mark on his recent entry regarding the DPM degree. I can also speak to his comment on the fellowship program at Dartmouth which had been a positive initiative for the profession, but it is simply not true that this is just getting started in the world of allopathic medicine. I completed the program at Dartmouth from 2002 thru 2004 in the initial MPH class and was taught by several MD/MPH faculty. I chose Dartmouth because of their initiative to change the business of what we knew as healthcare delivery and, for both good and bad, they were influential in forming the Affordable Care Act (Obamacare) and the development of what we know today as an Accountable Care Organization (ACO). They continue to be a leader in healthcare delivery innovation.
What I don't think Paul realized is that with present financial constraints on APMA, they have chosen to place their priorities elsewhere and discontinued funding for this fellowship program. This program provided the opportunity for fellows like...
Editor's note: Dr. DiResta's extended-length letter can be read here.
07/28/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: DPM is NOT a Dead-End Degree; It Is Just a Starting Point
From: Paul Kesselman, DPM
Over the last few years, there has been an increase in the "bashing" of the DPM degree by many of my colleagues. Fortunately, there have been many of my colleagues who have called for this eternal bashing to stop. The reasons for those who are not happy with their current lot vary as do those who are satisfied with their careers. But I suspect there are many in the MD/DO, JD, accounting, and other fields who are also not happy with their current career path.
I am not an occupational sociologist or psychologist and cannot get into the mindset of those who constantly bash this profession or specialty (that too seems to be debatable). The purpose of this letter is to demonstrate that there are many individuals who have taken their DPM and used it as a springboard to go...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/21/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: STAND+ Shoes (Jack Ressler, DPM)
From: H. David Gottlieb, DPM, Robert Scott Steinberg, DPM
First, I have no relationship with STAND+ Shoes. I received a pair of these shoes for evaluation after a meeting in DC last year. I was told they were meant for standing in all day, hence the name. Also, they were heat moldable/adjustable with a hair dryer, as well as non-absorbent and machine washable. They sat in the box for a couple of months before I tried them on.
They are now my favorite shoes and all of the claims made by the company are true. I highly recommend them for anyone. I am not associated with STAND+ nor do l have any financial inducement to recommend their shoes.
H. David Gottlieb, DPM, Baltimore, MD
How does the APMA determine who is eligible to receive its Seal of Approval? Do the companies whose products are endorsed by the APMA advertise with the APMA?
Robert Scott Steinberg, DPM, Schaumburg, IL
Editor’s comment: The APMA Seal of Acceptance and Seal of Approval are granted by the APMA to products that promote good foot health. The Seal of Acceptance is awarded to footwear, insoles, and materials, while the Seal of Approval is given to therapeutic products like lotions and medicines. These seals indicate that a product has been reviewed by podiatrists and found to be beneficial for foot health, safety, and quality. Source: APMA
07/15/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: DPMs as Foot Experts?
From: Jay Grife, DPM, JD
As a former practicing podiatrist, I appreciate the comments extorting the population to accept podiatry as the leader in foot care and treatment. I also have noted from learned persons such as Dr. Tomczak whom I admire for his honesty and devotion, the devolution of podiatry. What I read as quoted below displays that podiatrists are omitted from a topic they see daily and likely treat more often than other healthcare providers. Lest we listen and react to Dr. Tomczak’s prescient explanation, I fear he might be right.
From Health: “Toenail fungus can begin as a minor cosmetic issue, but if left untreated, it may become painful and harder to treat. ‘The signs of toenail fungus are thickened nails that are hard to clip, might appear yellow or white, and can sometimes crumble,’ explains Jeffrey M. Cohen, MD, a board-certified dermatologist and Director of the Psoriasis Treatment Program at Yale School of Medicine.
After consulting with two dermatologists for their expert recommendations, we tested six toenail fungus treatments ourselves. A dermatologist from our Medical Expert Board also reviewed this article for medical and scientific accuracy.”
Jay Grife, DPM, JD, Jacksonville, FL
06/30/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Steven Finer, DPM
I agree with Dr. Lai. Unless your initials say MD or DO, we will always be placed with that other group. Look what the DOs have accomplished since the 1970s.
Steven Finer, DPM, Philadelphia, PA
06/27/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Degree, Not Training: The Parity Gap Facing Podiatrists
From: Jengyu Lai, DPM
I joined the American College of Lifestyle Medicine (ACLM) ten years ago, excited to be part of a growing movement focused on evidence-based, whole-person care. When ACLM began working toward official specialty recognition, I was excited—but then surprised to learn that podiatrists would not be recognized as physicians within the specialty but instead classified as allied health providers. This decision was not based on differences in clinical training, residency, or capability, but solely on the degree—DPM rather than MD or DO.
Many ACLM members voiced support for including podiatrists as physicians, but the final determination rested with the American Medical Association. When lifestyle medicine was officially recognized as a specialty in 2019, DPMs were excluded from physician designation. I initially refused to pursue board certification. However, after meaningful discussions with a friend and ACLM board leader, I eventually completed the exam. I am now a diplomate of the American College of Lifestyle Medicine—not the American Board of Lifestyle Medicine—and classified alongside NPs, PAs, nurses, dietitians, and therapists.
This experience highlights an ongoing issue: the lack of parity for podiatrists stems not from training or expertise, but from degree classification. As healthcare continues to evolve and new specialties emerge, such as wound management, this degree-based disparity may persist—potentially sidelining podiatrists despite our central role and qualifications in those fields.
Jengyu Lai, DPM, Rochester, MN
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.
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