From: Jon Purdy, DPM
Podiatry is unique in some ways and mainstream in others. When my father was in practice, it was a time when podiatry schools were accepting students not academically able to get into medical school. Reimbursements at the time were significantly higher and insurance was not a limiting factor. It was an easier path to a high return on investment.
Fast forward to our somewhat better acceptance into mainstream medicine, advancement in our education and training, as well as scope of practice. This has led to an increase in time, educational costs, and a higher bar for acceptance to podiatry schools. The medical practice environment has slashed the return on investment for everyone. We have inadvertently leveled the playing field while maintaining a narrow scope of practice. This without a doubt has made one’s decision to go into podiatry less appealing.
Orthopedics began as a pediatric deformity specialty. Modern ortho for the most part abandoned the babies, and most ortho practitioners limit their practices to certain joints and body parts. Podiatry is no different. We have evolved, and let’s face it, have painted ourselves into a corner of modern medicine. We are being outpaced by nurses of all things. We have serious decisions to make about our profession and its leadership. Letting titles, history, and ego stand in the way will be of no help.
Jon Purdy, DPM, New Iberia, LA
From: Allen M. Jacobs, DPM
It seems to me that the majority of contributors to PM News are of the older generation such as Kesselman, Udell, Warshaw, Secord, Ribotsky, Oloff, Tomczak, myself, and many others. In general, these are individuals who have devoted a portion of their lives to efforts at the advancement of this profession through the participation in educational activities. I suspect the majority of PM News readers are of the same generation, as we seldom witness commentary from younger podiatric physicians, as can be seen, for example, on the podiatry student network.
As a direct consequence of decreased college enrollment, we are now witnessing a phenomena which was unimaginable years ago: unfilled residency positions. It is ironic than at a time that our profession has reached the summit of integration and acceptance in medicine, for which our podiatric forefathers such as Earl Kaplan and Dalton McGlamry, ...
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Ivar Roth, DPM, MPH
I always get a chuckle out of reading Dr. Jacobs’ responses to some of my posts. Here are some of my observations after I completed a comprehensive 3-year residency in foot and ankle surgery some 40 plus years ago.
Having been blessed and trained to have excellent hand eye coordination from performing surgery, I adapted and used these skills to what I consider perfecting the medical pedicure. From my close association to routine care and what I saw daily... athletics foot, fungus nails, and IPKs... I was able to come up with cures and I do not say that lightly for athletics foot, fungus nails, and recently the resolution of IPKs... all of these conditions which have been hopeless to resolve until now. I am currently in discussions with academic centers to have FDA studies done to prove what I have discovered and bring these cures out to the public. I envision podiatrists leading the way so we can claim some glory and re-imagine what podiatry has to offer to the medical community. Again, thanks to Dr. Jacobs for his pithy comments.
Ivar Roth, DPM, MPH, Newport Beach, CA
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Fifty-three years ago when visiting podiatrists before committing to podiatry school, I visited a number of podiatrists who wore a nylon jacket similar to what a dentist or optician wore. Almost everyone of the podiatrists would ask the patient what was wrong and while the patient explained, the podiatrist pulled a large bone cutter out of the jacket pocket and started cutting toenails. The podiatrist would say something similar to, "Let me shorten these nails while we talk." As a third -year student at OCPM, an older lady asked me if I was going "to paint her nails" when I concluded cutting them? Thank God I had a spray bottle of Merthiolate to make the experience an "antiseptic pedicure."
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/06/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Bret Ribotsky, DPM
Dr. Teitelbaum has once again put his finger on a wound that has festered for decades. The “routine foot care” designation is not merely a billing inconvenience — it is an institutional insult that has shaped how our profession sees itself, and perhaps more importantly, how we allow others to define our worth. But I want to add a perspective that the reimbursement debate sometimes obscures: the label matters far less than the performance.
Whether CMS calls it routine or not, whether we are classified as allopathic, specialty, or profession — none of that determines the ceiling of what an individual practitioner can achieve. What does determine it is the quality of care delivered, the skill of communication with the patient, and the ethical clarity with which a fair value is established for...
Editor's note: Dr. Ribotsky's extended-length letter appears here.
05/06/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1A
From: Allen M. Jacobs, DPM
Medical pedicure Dr. Roth? "Medical pedicure" is a euphemism for cutting toenails or calluses. Seven years post-graduate education for a "medical pedicure"? Making toenail and callus trimming more palatable and profitable for you by equivocation does not alter reality. Seven years and greater than $250,000 debt are not justified for the provision of a "medical pedicure". Equivocation may assist you in attributing greater significance to what you do rather than the reality that cutting toenails and calluses is just that, cutting toenails and calluses. The provision of these services may be necessary for some patients, but as they say, "let's call a spade a spade". In the old days, they called it by the German adverb "schneiding". Medical schneide anyone?
Allen M. Jacobs, DPM, St. Louis, MO
05/05/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1B
From: Paul Kesselman, DPM
This article was written almost three years ago and published in Nov/Dec 2023, but based on the feedback just revived, it must have been recently re-posted. I searched both my manuscript and the edited published copy and don't see where I specifically defined podiatry under allopathic. Having said that, Dr. Teitelbaum, brings up an interesting question. Is podiatry allopathic or something else? I am not sure this article ever took a position on this.
Searching the web for a uniform definition of allopathic medicine, I used an AI tool which from the Univ. of Kansas describes allopathy as follows: Allopathic medicine, or "conventional medicine," is a modern, evidence-based system where healthcare professionals (doctors/MDs) treat diseases and symptoms using drugs, surgery, and radiation. It focuses on...
Editor's note: Dr. Kesselman's extended-length letter appears here.
05/05/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1A
From: David Secord, DPM
I thought that the comment upon the use of the term allopathic here was entertaining. I have commented in this listserv about 10 times about the meaning of the term allopathy and had a submission to Podiatry Today published some years back on the topic. This is an excerpt:
As long as I’m on a roll here, I thought I’d also comment on people in our profession referring to MD and DO medicine as allopathic and osteopathic and then putting ‘podiatric medicine’ in a separate category, as if podiatric medicine wasn’t allopathic medicine. There are a certain finite number of medical theories out there, including allopathic, osteopathic, homeopathic, chiropractic, native American Indian pan-theistic naturopathy, witch doctors, Eastern Indian Ayurvedic medicine and...
Editor's note: Dr. Secord's extended-length letter appears here.
05/04/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1B
From: Ivar Roth, DPM, MPH
Dr. Teitelbaum makes many good points that make sense. As medicine's stepchild, we are treated as second class citizens in terms of the medical bureaucracy. But cutting corns calluses and nails is something that could be accomplished by the individual or nail technicians in salons in certain states. If the door to insurance was opened up, everybody would want that “FREE” insurance covered treatment. This is why I think the current process really does make sense and allows the individuals to make that choice if they are willing to pay for our services.
At my office, we offer medical pedicures and we are really busy doing a great service to the community and making a nice living at the same time. I encourage all podiatrists to rethink routine care as medical pedicures and I think you will be very happy with the results.
Ivar E. Roth, DPM, MPH, Newport Beach, FL
05/04/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1A
From: Jeff Pinsky, DPM
In response to Dr. Teitelbaum’s response to Dr. Kesselman’s look back and musings on routine foot care’s non-coverage by Medicare as a contributing factor to podiatry’s perceived lesser status among medical professions, I felt I had to jump in. I started practice 40+ years ago as well. I did lots of “routine foot” care while in practice. Most was under the non-covered guidelines from Medicare. Even though a minority had class findings, I could fill a stadium with those who did. Notes were well documented (back in the days before A.I. note generation and scribes) with the why and what of each visit, and I never had an issue with Medicare denials or inquiries. I was never looked down on by my MD and DO peers. Yep, we considered each other as equals, as were the local dentists; audiologists, not so much. I think it’s the retail aspect that put them “one rung down the professional ladder”.
And about dentistry: at least in my practice region, there were more unmet routine dental needs than routine foot care needs. Medicare’s non-coverage of dental care doesn’t affect dentistry’s status one bit. We need to feel no shame in doing routine foot care to reduce pain, discomfort, and risk for our patients.
Jeff Pinsky, DPM, Petersburg, VA
05/01/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Robert D Teitelbaum, DPM
Paul Kesselman's Podiatry Management article about "allopathic" medicine and how DPMs are allopathic doctors was a great lesson in the real meaning and the corruption of common words that we use to describe our professional status. I would also like to bring up three words that have held us back professionally and consistently for 40 years and I have not seen them much talked about. Those three words are "routine foot care".
My thesis is this:
1. There is no complaint about foot pain that is routine. A patient who realizes that her bent 2nd toe has a painful corn on the first joint that hurts in all shoes is in distress. They need someone to counsel them on the choices they may face and the treatments that are relevant. The patient wants our experience, knowledge, and ability to communicate. They want a plan of action--in other words they want...
Editor's note: Dr. Teitelbaum's extended-length letter appears here.
05/01/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1
From: Joel Lang, DPM
When I first opened my practice, I had a great mentor, Dr. Charlie Turchin, a diamond in the rough. He taught me that if I could not earn a living in 50 weeks, working 52 would make no difference.
Another mentor was my practice management professor at the New York College, Dr. Elizabeth Roberts, who taught me to practice on my first day the way I wanted to be practicing 10-20 years later. Don’t start one way, thinking that someday you will change. You probably won’t (though in some ways I did).
Combining these two pieces of advice, I decided that I wanted and deserved a 2-week vacation each...
Editor's note: Dr. Lang's extended-length letter appears here.
01/31/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Allen M. Jacobs, DPM
The recent discussion of the Lymphedema Act and the ability of the podiatric physician to be reimbursed for the dispensing of certain products such as compression garments as an aid for the management of lymphedema is helpful for understanding the economic and coding aspects of lymphedema. However, I believe the clinical issues discussed in this article require a more detailed and accurate discussion.
Editor's note: Unfortunately, this extended-length letter which appeared in the 1/29/26 issue of PM News included only the first part of Dr. Jacob's response. To read the entire letter, click here.
06/30/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Rod Tomczak, DPM, MD, EdD
If you read the recent article titled, “Our House is on Fire” in Podiatry Management, it’s probably because you have some interest in podiatric education. You still have a large loan for your education, you are looking to hire a new associate/partner, thinking about selling your practice to a future graduate, teach at one of the podiatry schools, are a podiatric residency director, or are a current podiatry student. That pretty much takes care of the whole profession and, I might sum it all up by stating, “You have a skin in this game.”
Dr. DeHeer reminded me that it’s easy to be a Monday morning quarterback when tragedy arises. Almost as easy as it is to scream, “Monday morning quarterback.” By now we expect more. Let me remind Dr. DeHeer that, as President of the APMA, he has moved through all the chairs and probably has some thoughts about podiatric education. I guess everyone missed the proverbial light at the end of the tunnel not being daylight but...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/10/2024
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Paul Kesselman, DPM
The article cited in a recent PM News edition requires some updating. Since it was written and published, CMS has made a change with respect to the process of prior authorization of bone stimulators. Due to some technical issues with various generations of this technology, CMS last week announced that they were halting the prior authorization process on bone stimulators. When enforcement of this process takes place, CMS promises to make another announcement.
Paul Kesselman, DPM, Oceanside, NY
09/10/2024
RESPONSES/COMMENTS (PM ARTICLES) - PART 1
From: Ali Davis, DPM
I just wanted to make a comment about the AI article recently written. I have explored AI in my practice but a big concern is the reason this is free or cheap to us is because they are planning to phase us out- we are feeding the computers the data and knowledge to phase us out- it is allowing computers to collect data and eventually a company will use this to charge patients money to diagnose and treat themselves- not good for our profession. I personally do not plan to use this technology as it is helping to phase out physicians. It is not good for our profession.
Ali Davis, DPM, Overland Park, KS
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) -PART 1
From: James Koon, DPM
I closed my practice 8 years ago to join a multi-specialty clinic. I got one records request in the 7 years I had to keep the records. One. I called the requestor and was released from it as my contribution was nominal. I simply kept my server. My vendor, MacPractice, assured me that IF I ever needed a chart, they would be able to pull it off my server no matter how many software updates transpired. For a fee. I never needed it.
We did have some residual paper charts that I rented a storage space for and pared them yearly. I paid to have them shredded. I also sold my x-rays for the silver recovery. Both were an expensive and laborious endeavor. In retrospect, I should’ve just had a big bonfire and partied with friends.
Closing a practice takes longer than you think and costs more than you think. Bills come out of thin air for months. Banking costs, vendor contract terminations, x-ray equipment decommissioning costs, files, legal notifications, etc. I don’t envy anyone doing it. I love being an employed physician.
James Koon, DPM, Winter Haven, FL
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2B
From: Robert D Teitelbaum, DPM
David Secord's posting recently about "allopathic" medicine and how DPMs are allopathic doctors was a great lesson in the real meaning and the corruption of common words that we use to describe our professional status. I would also like to bring up three words that have held us back professionally and consistently for 40 years and I have not seen them much talked about. Those three words are Routine Foot Care.
My thesis is this:
1.There is no complaint about foot pain that is routine. A patient who realizes that her bent second toe has a painful corn on the first joint that hurts in all shoes is in distress. They need someone to counsel them on the choices they may face and the treatments that are relevant. The patient wants our experience, knowledge, and ability to communicate. They want a plan of action--in other words they want...
Editor's note: Dr. Teitelbaum's extended-length letter can be read here
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2A
From: Robert Kornfeld, DPM
Dr. Kesselman makes a powerful point. But it isn’t limited to DPMs as to under-valuing services. I am friends with many MDs and the ones who still accept insurance suffer the same issue. The system has conditioned patients to not want to pay for anything so doctors feel their services have no value. I used to share an office with a cosmetic dermatologist and a plastic surgeon. They collected enormous amounts of money every day from their patients, and my patients often refused to pay co-pays and deductibles.
I went to a direct-pay model almost 24 years ago. I decide what my services are worth. I set my own fees. Every patient pays my full fee at the time of the visit. My accounts receivable has been $0 all these years. And I have made almost double the net income on 8-10 patients daily than I made on 50 insurance patients daily. Honestly, it’s a choice. I do not work hard. My days are pleasant and stress free. No one has to be exploited and abused by insurance companies.
Robert Kornfeld, DPM, NY, NY
12/13/2023
RESPONSES/COMMENTS (PM ARTICLES) -PART 1
From Ron Werter DPM
Dr. Kobak has written an in-depth article in PM Magazine about closing a practice. There is one item I have a question about: preserving the charts. When we all had paper charts, we could put them in boxes and take them home or have a company store them for 7 years Now, most of us have an EHR which is administered by a vendor. What is the best way of retaining those charts? Are there known problems with asking the vendor to copy all the data and allow it to be accessible if you no longer have their program.
Ron Werter, DPM, NY, NY
12/13/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Paul Kesselman, DPM, Mark Spier, DPM
The whole point of my last letter was to point out that we, as individuals, are partly if not totally responsible for setting our own self-worth. If we don't, who will? If we podiatrists, as Dr. Secord states, are allopathic physicians, then it’s time we start acting like ones.
Can you find me an MD or DO who will work for the kind of dollars DPMs line up and stab each other in the back to sign up for? And that is the crux of the problem. We think if we sign up for less, then we can become invaluable to the patient and carrier. In fact, that’s exactly the opposite of what happens. The carrier realizes we are so dependent on them, we become so desperate to retain their lifeline, that they pay us less and less. So who’s really responsible for this? Each of us!
Paul Kesselman, DPM, Oceanside, NY
I’m asking if the antipathetic allusion to allopathy is an anonymously announced alliterative allegory? Or is it not necessarily nuanced enough to notice now?
Mark Spier, DPM, Reisterstown, MD
12/05/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: Mark Ross, DPM
Dr. Rothenberg said, “Diabetic is a label and should be avoided. Compliance is authoritative and stigmatizing." To an old-timer getting ready to be put out to pasture, my response is, “The truth shall set you free.”
We accept great responsibility when treating diabetics, particularly those with infections, ulcerations, osteomyelitis, and gangrene. Compliance always affects outcomes. Failure is not an option, but can happen and when it does, the onus is on us.
The most important thing a doctor can tell their patient is the absolute truth. And patients know when the doctor is lying. Give the patients credit. When the patient is told they’re going to lose their toe which could very well lead to loss of limb, which could lead to death within five years, they are not dwelling on your choice of words. They are looking to the doctor to save them. And that is our job.
Mark Ross, DPM, Yardley, PA
11/30/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 3
From: Janet McCormick, MS
I agree with most of Dr. Roth's comments concerning extenders. Medical nail technicians (MNT) do leave for many reasons, as do other extenders in offices - few of us in business have the same staff as five years ago. To counter this, I provide podiatrists ways to keep them, such as suggesting an Educational Agreement and proper pay, and more. If they continue to leave, then I always make a suggestion toward an evaluation of staff management practices. I also suggest a friendly exit to all when and if it happens, that a well nurtured referral system can be very profitable on both sides between an MNT and a podiatry practice. Wise podiatrists who build this referral system see new clients from this collaboration on a continual basis.
Over the years, I have made comments comparing the dental scenario with dental hygienists, and podiatrists with extenders, and have mentioned that many years ago, dentists saw the handwriting on the...
Editor's note: Ms. McCormick's extended-length letter can be read here.
11/30/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Gary Rothenberg, DPM
I would like to applaud Luke Hunter and Amanda Miller for their recent article posted from Podiatry Management. As a podiatrist who has a career dedicated to prevention of lower extremity complications among people with diabetes, any opportunity to share thoughts on the significant relationship between mental health and diabetes outcomes is welcome. However, I ask that we take this article to the next level and realize that language and words matter.
A lot of work has been done in the diabetes education space around the importance of appropriate and acceptable language in treating patients with diabetes. By the title of the article and even though people with diabetes are a significant part of podiatric practices, our field is slow to catch on to the significance of the words we use. "Diabetic" is a label and should be avoided when referring to people with diabetes. "Compliance" is authoritative and stigmatizing. There are excellent references that can help us all communicate in a more sensitive and effective way, especially important for our patients with diabetes and concomitant mental health issues. Robin Sharma said, ‘‘Words can inspire. And words can destroy. Choose yours well."
Lewis DM. Language Matters in Diabetes and in Diabetes Science and Research. J Diabetes Sci Technol. 2022 Jul;16(4):1057-1058.
Speight J, et al. Our language matters: improving communication with and about people with diabetes. Diabetes Res Clin Pract. 2021; 173.
Dickinson J, et al. The use of language in diabetes care and education. Diabetes Care, 2017; 40(12): 1790-1799.
Gary Rothenberg, DPM, Ann Arbor, MI
