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05/18/2023
RESPONSES/COMMENTS
RE: Unequal Treatment of Ex-Patriot DPMs by ABPM
From: Jeff Carnett, DPM
There are many of us American trained DPMs working overseas who are not eligible to be board certified by either board as we did one or two-year residencies, but not three-year programs. So, how shocking to see that ABPM will certify those with bachelor degrees in podiatry from the UK, SA, Australia, Malta, and New Zealand who did not take the MCAT, have no basic medical sciences in their courses, and no residencies. These degrees are right from high school.
Doesn't that discredit anyone with the ABPM certification in the U.S.? So, we expatriate DPMs need to take a bachelor podiatry degree so we can get certified, but we can't get certified with a CPME-approved DPM degree and residency? I’m trying to understand how that helps the profession. While overseas, our work is often highly surgical, but alas that doesn't count.
Jeff Carnett, DPM. Auckland, New Zealand
Other messages in this thread:
04/06/2026
RESPONSES/COMMENTS (PODIATRISTS AND BURNOUT)
From: Samuel Makanjuola, DPM
I find some things interesting after seeing the projected shortages for podiatrists by the National Center for Health Workforce Analysis. First and foremost, their projection for 2026 right now, is that there is a 2000+ podiatrist shortage. Surprising seeing how many grads are having trouble finding jobs where they are located.
Secondly, and more importantly, did anyone notice it said "as part of "wider allied health shortages?" I did. So I double-checked the source. The MSN "article" if it can be called that, was AI-generated and has no link to the actual NCHWA information. No issue, I can just go directly to them. Upon doing so I found that while they specify many different types of "physicians" in their analysis, they do not include podiatry in their physician category but rather as...
Editor's note. Dr. Makanjuola's extended-length letter can be read here.
04/06/2026
RESPONSES/COMMENTS (AI)
RE: AI In Your Future?
From: Paul Kesselman, DPM
In a recent Becker's Spine Review, there is an interesting quote which should cause concern. "AI is coming fast and being widely employed before it has been refined. AI slop is going to be a big problem. Patients are being guided by an AI agent that generates unrealistic expectations and creates confusion. The surgeon will have to find a way to get ahead of the conversation, but this will be challenging. AI billing agents are communicating with each other (from the practice and from the insurance companies). The result will be a drive to oversimplification, delay and inaccurate reimbursement."
As one can see, while we as providers think we have the upper hand by using AI to insure our charting and documentation adheres to the third party payer policy, the insurance carrier is doing the same thing. Their systems may be more robust, than ours, but perhaps not. The AI chatting going back and forth will no doubt as the article states create significant delays, inaccurate payments and outright denials, even for clean claims.
Paul Kesselman, DPM, Oceanside, NY
04/03/2026
RESPONSES/COMMENTS (MIPS)
RE: Podiatry and MIPS in 2026
From: Michael Brody, DPM
The reporting period for the MIPS for 2025 is now over and it is time to look at MIPS for 2026. One of the biggest changes in MIPS for podiatry is the new podiatry MIPS Value Pathway (MVP). Kudos to the APMA for working with CMS to have this pathway created.
With the Podiatry MVP, there is a short list of measures that are relevant to the practice of podiatry. When a podiatrist elects to participate in the MVP, they are only required to report four (4) measures rather than the six (6) required for traditional MIPS. This change alone reduces the burden of reporting by...
04/03/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY)
From: Jeffrey Kass, DPM
Dr. Ribotsky’s point is well taken, but his post failed to mention that many provider contracts have a built-in clause that doesn’t allow for a practitioner the ability to bill for a service without first billing the insurance company. This includes services one may think is “non-covered”. A colleague recently billed a patient for a wart treatment with a microwave machine. The insurance company expelled the doctor from the plan because he did not first bill the insurance company and hence the doctor did not know whether the service would be paid for or not.
I have a different take on the matter. I agree fee reductions are not keeping pace with the cost of inflation. Ancillary services are one way of bringing in extra income to a practice. The other is being reimbursed at a fair rate. This is the real problem. I don’t understand why the medical profession runs away from the etiology. As podiatrists, we are always taught to treat the root cause of the problem. This scenario should be no different.
Doctors need to break the shackles of “you’re not allowed to strike”. Nurses make headlines every couple of years and they always end up with better deals than they had. Every profession strikes and then they compromise and come out better. If striking is illegal, we need to find a way to make it legal or have the law changed. This is the real solution. Everything else doesn’t “solve the root cause of the problem”.
Jeffrey Kass, DPM, Forest Hills, NY
04/03/2026
RESPONSES/COMMENTS (CALL TO ACTION) - PART 1B
From: Allen M. Jacobs, DPM
Just for the record Dr. Oloff. Not only does the Good Feet Store chain have orthopedic consultants, they also have paid podiatry consultants. I must admit that I was taken back by this realization when a DPM consultant spoke on their behalf at a dinner meeting associated with a state meeting.
My former billing supervisor was on a recent cruise. The cruise ship advertised a free screening by the Good Feet Store for undiagnosed foot problems. She attended to see what they do and to inform me. They diagnosed her with “pronation” and attempted to sell her over $1000 of pre-made...
04/03/2026
RESPONSES/COMMENTS (CALL TO ACTION) - PART 1A
From: Philip Radovic, DPM, Robert Scott Steinberg, DPM
Philip Radovic, DPM, San Clemente, CA
I never use the word "custom." I dispense prescription corrective, i.e. posted functional foot orthotics. I use plaster because DCs, PTs, CPeds, shoe stores cannot or won't take the time, and don't have the training or experience.
Robert Scott Steinberg, DPM, Schaumburg, IL
04/03/2026
RESPONSES/COMMENTS (SUBSTANCE ABUSE & ADDICTIONS)
From: Joel Lang, DPM
What incredible courage to share this with so many. Best wishes and thanks for your contribution to the profession, your community, and the world.
Joel Lang, DPM (retired), Cheverly, MD
04/02/2026
RESPONSES/COMMENTS (SUBSTANCE ABUSE & ADDICTIONS)
RE: Everyone Has a Drug of Choice
From: Rod Tomczak, DPM, MD, EdD
I wasn’t sure how to start this letter, then I decided to begin the way I’ve started thousands of other meetings, with a stammer in my voice and say, “My name is Rod Tomczak (I choose to use my last name) and I’m an addict and an alcoholic and I last used 20 years ago.” Verbalizing the self-diagnosis gets easier after the first five years or so.
Everyone, and I mean everyone, has a drug of choice. For some people it’s not alcohol or a controlled substance. It might be gambling, plastic surgery, shopping, golf, eating, sex, money, work, power, working out, the Internet, or watching TV. It’s something that too much throws your life out of balance. For the longest time, I told people my drug was Absolut. I was absolutely wrong, but I did put it before my family.
In August of 1999, I broke out in....
Editor's note: Dr. Tomczak's extended-length letter appears here.
04/02/2026
RESPONSES/COMMENTS (PRIOR AUTHORIZATION)
RE: Mandated Publication of Prior Authorization Rates
From: Paul Kesselman, DPM
Yesterday's Becker Payer has a story related to mandated public posting of prior authorization issues for Medicaid, Managed Medicaid and Medicare, and CHIP plans. This includes denials rates, how often they are processed, and how often denials are overturned on appeal. The first reports are due today, March 31 under a rule finalized by Medicare in 2024. The only metric not subject to such posting are pharmaceutical denials. That means diagnostic and therapeutic tests and procedures, DME, etc.; all must have those metrics noted posted for publication.
Additionally, these carriers must process standard prior authorizations within 7 calendar days (currently 14) and urgent requests within 72 hours. Payers must provide specific reasons for the denials and communicate through their portals, faxes, email, mail, or phone. As was posted the other day, communication via fax and mail will be discontinued over the next year or so.
Paul Kesselman, DPM, Oceanside, NY
04/02/2026
RESPONSES/COMMENTS (OBITUARIES)
RE: Celebrating the Wonderful Life of Hal Ornstein, DPM
Sunday April 26th at Howell High School Indoor Gymnasium, 405 Squankum-Yellowbrook Road, Farmingdale, NJ 07727, Doors open at 12:25 PM. Ceremony at 1 PM.
04/02/2026
RESPONSES/COMMENTS (CALL TO ACTION) - PART 1C
From: Elliot Udell, DPM
Ever since I entered podiatric medical school back in the late '70s, this argument has been with us. "What right does a non-podiatrist have to measure for, cast, and dispense foot orthotics?" For better or for worse, shoe stores, chiropractors, orthotists, and whoever else has the desire is legally allowed to dispense shoes and "arch supports."
What I find interesting (and at times nauseating) is that "The Good Feet Stores" created a business model where they charge "1500 dollars" for a set of orthotics, and their customers will not say boo. They are not even handmade for the patient.
In podiatric practices where we are highly trained to cast for and to dispense custom orthotics, we often encounter patients who will not consent to having orthotics unless their insurance pays for them. The out-of-pocket price that most of us charge is between 400 and 600 dollars and many patients will walk away. What can we do? To quote Bob Dylan, "the answer my friend is blowing in the wind."
Elliot Udell, DPM, Hicksville, NY
04/02/2026
RESPONSES/COMMENTS (CALL TO ACTION) - PART 1B
From: Joan Oloff, DPM
I would like to thank Dr. Whelan for taking the time to shine a light on what has become a significant problem for many patients in my area. There is a Good Feet Store close to where I practice. As a result, I frequently see patients who share their experiences in the store.
As Dr. Whelan stated, the salespeople in their stores are trained to confuse the public into thinking they are medical professionals. These salespeople are the sole evaluators and “prescribers” of the treatment plan. Patients are “prescribed” 3 OTC arch supports (which they are told are individualized for them) and a pair of Brooks sneakers. The total cost of this “treatment” is $2,000. I had one lady come in to see me and she started crying in the treatment chair. These patients are embarrassed when they realize they were...
04/02/2026
RESPONSES/COMMENTS (CALL TO ACTION) - PART 1A
From: Michael Schneider, DPM
Excellent article from Dr. Whelan. I’m retired now but recall seeing patients who have had negative experiences at “The Good Feet Store”. The advertising here in Colorado is seductive. I recommend that anyone thinking about going to these stores Google reviews and contact the Better Business Bureau. Eye opening!
Michael Schneider, DPM, Denver, CO
04/01/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Gary S Smith, DPM, Paul Betschart, DPM
There is a fuse in the back on the control panel. It looks like an automobile fuse, but it is alternating current. Also, on the left-hand side of the chair along the bottom edge there is a small toggle switch that turns the chair off. It sometimes can be turned off by cleaning staff. If that doesn't work, you may need a new control panel. When you say you have power to the receptacles, what does that mean? If they will run a device or a lamp then they are good. I have seen them "test" positive for power and not run a device because the ground cord was broken.
Gary S Smith, DPM, Bradford, PA
Try checking the fuses in the back of the chair. The plastic cover is attached by 4 screws on the seat back. There are 3 fuses on the processor panel which may have blown. Happened to mine once. A new fuse fixed it.
Paul Betschart, DPM, Danbury, CT
04/01/2026
RESPONSES/COMMENTS (CALL TO ACTION)
RE: When Did Buying Arch Supports Become a Medical Visit?
From: James Whelan, DPM
A patient recently sat in my clinic and told me he had already been “evaluated”, not by a physician, and not in a medical office, but at the Good Feet Store. He stood on a scanner, was shown a digital image of his feet, told he had “flat feet,” and was sold a pair of “custom orthotics” for over $1,500. He came to me because he was still in pain.
This story is no longer unusual.
Across the country, retail storefronts, most prominently the Good Feet Store, are offering foot scans, labeling conditions, and recommending treatment, often without physician involvement. To patients, the experience feels indistinguishable from a medical evaluation. That perception is not accidental, but...
Editor's note: Dr. Whelan's extended-length letter appears here.
04/01/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY)
From: Bret M. Ribotsky, DPM
Dr. Jacobs has written a thoughtful and honest analysis of the perception problem confronting podiatric medicine. I write to add a dimension that deserves equal weight: the economic reality practitioners face — and that prospective students are quietly calculating before they ever submit an application. Put plainly, when adjusted for the cost of living, many of us were working for 17 cents on the dollar compared to a generation ago. That is an 83% effective decline in professional compensation. Perception may be a problem. But that number is not a perception.
Dr. Jacobs correctly notes that AI/Google cites high student debt and poor return on investment among the factors driving declining applications, and he counters that many podiatrists do very well financially. That is true in aggregate. But it obscures a more granular truth every practicing podiatrist knows: reimbursement has been in steady decline for decades while the cost of running a practice...
Editor's note: Dr. Ribotsky's extended-length letter appears here.
03/31/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Podiatry and the Perception Paradox
From: Allen M. Jacobs, DPM
There is often a significant difference in the manner by which we perceive ourselves and how others perceive us. It is called perception paradox. It has been said, “if we could see ourselves the way that others see us, we would be amazed.” With an aging population, the diabetes pandemic, obesity, increasing sporting activities in all age groups, the demand for foot and ankle services has been increasing. Every evaluation of the question concludes the increasing need for foot and ankle care. This will continue to increase in the future.
Why then the decreased application rates at the colleges of podiatry?
I decided to look at an AI/Google search to determine if we as a profession suffer from perception paradox. How do non-podiatric physicians view the issue of declining applications to the colleges of podiatric medicine. In my opinion, the “outsiders view” of this problem is...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/31/2026
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Richard A. Simmons, DPM
I have not used a grinder for debriding toenails in more than twenty years. I saturate the nails with a mixture of water with hand soap and use my nipper to reduce the nail plates. When finished with the nipper, I use a surgical hand rasp to smooth them out. During my initial debridement, I am dictating my notes to my transcriber who goes through all the class findings and the complete lower extremity exam.
For subsequent visits, I rarely bill anything more than CPT 11720 and often only debride one toenail and bill the rest at G0127, that is only trimming the length of the nail and not reducing its thickness. All of my initial Medicare patient mycotic toenails are sent to the lab for determination. My practice focuses on the medical management of mycotic toenails with debridement as secondary.
Richard A. Simmons, DPM, Rockledge, FL
03/31/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Philbert Kuo, DPM
Although I do not have the same model chair, I had a similar problem where the tilt stopped working but the back still moved. Midmark told me to remove the cover on the back of the chair and switch the plugs which are labeled. This worked. Maybe something is loose if you’re not getting any power. If the position of the chair is acceptable, consider leaving it in a fixed position… your patients will probably not mind.
Philbert Kuo, DPM, Chesapeake, VA
03/31/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Pete Harvey, DPM, Vincent Marino, DPM
I had two Midmark 417s and they were great chairs. You might get in touch with a local dental repair. They frequently work on Midmark no matter the age of the chair. My first thought is the connection of the foot control to the chair base. There is a plug there like the old telephone connecter. I once had to have that connector replaced, and the chair was good as new.
Pete Harvey, DPM, Wichita Falls TX
Even though there is power to the chair, you probably need to check the motor itself. Is there power to the motor or is the motor fried? Sounds like an issue with the motor itself.
Vincent Marino, DPM, Novato, CA
03/31/2026
RESPONSES/COMMENTS (MEDICARE NEWS)
RE: Medicare Claims Savings of $780M Per Year with Mandatory Use of Provider Portals
From: Paul Kesselman, DPM
A recent CMS publication estimates that mailing and faxing documents costs Medicare over $780M per year. Hence, moving forward, CMS agencies over the next two years will begin discontinuing acceptance of fax or snail mail documents. As of May 2028, CMS agencies will no longer accept documents via mail or fax. The portals which every CMS agency have are free and are far more efficient than faxing or mailing documents.
Faxing only proves you sent a document, but it is not accepted as proof that it was received. That may seems illogical but it is nonetheless true. Fax messages also often get interrupted and hence can be very frustrating when attempting to fax multiple pages. Snail mail no matter the agency used, (e.g., UPS, USPS, Fed Ex. etc.) are all expensive, and what happens if the documents get lost?
As for portals, uploading all the documents is very efficient and you have instant proof of receipt (whether by snapshot of your desktop or an email receipt). You will know who you are dealing with at the carrier and have a resolution whether good or bad much sooner. You can also submit more documents easily if need be.
Paul Kesselman, DPM, Oceanside, NY
03/31/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY) - PART 1A
From: Robert Kornfeld, DPM
When I hear any doctor state that they became a doctor solely to help people, I have to question that reality. I think we all went into medicine to help patients. But would any of you have put in all the years of education and training (and DEBT) to pursue a career that did not have the capacity to provide a really good income?
Let's be honest. Is the reason that podiatry enrollment has dwindled over the years because of a loss of interest in the human foot? I think not. What I believe (and all you have to do is go to a podiatry conference to hear it) is that the majority of podiatrists are fed up with insurance and Medicare burdens and hassles and they DO NOT encourage young people to follow this path. They are miserable and....
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
03/31/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY) - PART 1A
From: Bret M. Ribotsky, DPM
Dr. Jacobs has offered a thoughtful and historically grounded perspective on the evolving business of podiatric medicine. His invocation of Sir William Osler reminds us all why we entered this profession. His concerns about industry influence, unnecessary procedures, and the ethical drift that can accompany a profit-first mentality are legitimate and deserve serious reflection by every podiatric physician — young and seasoned alike.
However, while we examine our own house, we must be equally willing to examine the patient’s role in the very crises Dr. Jacobs so passionately describes. He rightly points out that one-third of all diabetes spending is consumed by lower extremity infection, ulceration, and amputation. That statistic is staggering — and it is not solely the product of industry influence, inadequate...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
03/30/2026
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Allen M. Jacobs, DPM
Dr. Tomczak opines that our profession is now at the proverbial “fork in the road” with regard to a decision which may impact the very survival and existence of podiatry in the future. Indeed there are important decisions to be made. I am reminded of Art Fern, the Johnny Carson character and host of “the tea time movie” on the tonight show. If you recall, he always had Carol Wayne next to him. He would give driving directions, telling you to drive until you came to the Slauson fork in the road. He told us to “get out of the car, and cut off your Slauson.” Whatever direction the podiatry profession elects to follow at the fork in the road, let’s make certain we do not, as Art Fern would say, “cut off your Slauson.”
Allen M. Jacobs, DPM, St. Louis, MO
03/30/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: H. David Gottlieb, DPM
I would like to share an AI response, with references, on this topic. I stopped grinding nails in 2005. If there were still some rough spots when I was done [not often] I used a nail file. I suggest that the practice of grinding nails be discarded altogether. Every podiatrist, chiropodist, or nail tech reading this should have the manual dexterity to 'bust' nails in a way that doesn't leave sharp edges, in my strongly held opinion.
From this Gemini AI prompt "How long will nail debris remain airborne after grinding them in an office? Provide peer reviewed references" the following answer was returned: "Based on peer-reviewed research in podiatry and occupational health, nail debris generated by mechanical grinding is not a...
Editor's note: Dr. Gottlieb's extended-length letter can be read here.
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