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02/03/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: ABPM Non-Recognition of Residencies
From: Vladimir Gertsik, DPM
Since primary podiatric medicine, podiatric orthopedics, and other names are gone (with their respective residencies), it is time to acknowledge that most non-surgical podiatrists are pretty much the same. Some see more kids than others, some do more orthotics than others, but we are still mostly podiatrists. I appreciate the name change. But what I do not appreciate is the stubborn refusal of the Board to recognize their own residency types (now obsolete but nevertheless CPME-approved at their time).
All podiatrists who have in good faith completed a residency program should have a pathway to board qualification. ABPM does not recognize its own residencies! Why should these pathways ever be closed? This is absurd. If a 2-year residency was acceptable 20 years ago, why is it no longer acceptable? Do 20 years of practice count for anything? Apparently not. What are these boards trying to prove, and to whom? Since there is no logic in all this, I feel that this board is not legitimate.
Vladimir Gertsik, DPM, NY, NY
Other messages in this thread:
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
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
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 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.
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
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