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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:
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.
03/30/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY) - PART 1B
From: Daniel Jones, DPM
It makes me worried when I see reports of podiatrists relying exclusively on at-risk foot care for their income. Being solely dependent on a single Medicare rule, that we have ZERO control over, would give me serious concerns about the security of my future income. What if the POTUS, with a stroke of the pen, eliminated the provision that allows for foot care? Is this a far-fetched idea? DOGE certainly has found ways to slash billions in governmental spending, what makes this provision any different? What if this, or any future administration, or unelected CMS bureaucrat says that codes 11055-11057 and 11719-11721 are no longer covered services? Would that drive 90% of podiatrists out of business?
Ask any financial advisor how to minimize risk. and what do they say? Diversify. Relying on a single income stream for an entire practice is risky. I urge those in our profession who practice this way to expand your practice. Are you doing comprehensive diabetic foot screenings and the DM shoe program? What about advanced wound care, limb salvage, vascular screenings (ABIs, etc.)? Have you considered sports medicine and biomechanics (X-rays, orthotics, PRP, etc.)? These are directly adjacent to the 'At-risk foot' and should be part of all of our comprehensive patient care. One doesn't have to be throwing beams into a Charcot foot to make a good living in our profession or even spend more than a day or two in the OR a month to round out a practice. I encourage those of us who 'chip and clip' all day to incorporate just a single new treatment modality into your practice in the next 90 days. The survival of your practice may depend on it.
Daniel Jones, DPM, Casper, WY
03/30/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY) - PART 1A
From: Elliot Udell, DPM
I empathize with Dr. Jacobs for being upset that for many applicants to our medical colleges, the main incentive is making money and not the love of curing patients.
I had to chuckle because several years ago, my brother-in-law, who is a retired radiation oncologist, was conducting interviews for potential residents, and it bothered him that the first question that potential fellows asked was how much they could expect to make if they entered his specialty.
I walk into my office every day for the love of alleviating pain. This gives me pleasure and economics are far secondary but I cannot make a person wrong who borrowed over 200K and may have a family to support as well. The bottom line is for us come up with good ideas in addition to making money that will convince people to apply to our podiatric medical colleges.
Elliot Udell, DPM, Hicksville, NY
03/27/2026
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
RE: With the Stroke of a Pen
From: Rod Tomczak, DPM, MD, EdD
Many years ago, I was asked to evaluate the chiropody program at the Michener Institute in Toronto. The Michener prepares allied health science personnel such as radiology technicians, anesthesia assistants, cardiac stress testing techs, and the like. Chiropody is among other ancillary healthcare support programs.
Specifically, I was asked to determine if the chiropody program could be transitioned into a DPM podiatry program and what would it take to accomplish that educational feat. I spent eight days visiting the school, off-site externships, chiropodists in practice both private and employed by hospitals in Toronto and in other close by Ontario cities. I administered some old student tests to the...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
03/27/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Steven Finer, DPM
I read the vote on the survey. I was surprised to see 26% of nail grinders have no system for dust removal.
First of all, this introduces harmful debris into the air. This is a mixture of fungal elements and keratin. I personally know a podiatrist who developed a fungal throat infection. Secondly, a great deal of time will be wasted cleaning this room. A professional unit won’t break the bank. So guard your health, that of your patients, and present a more modern approach to your patients.
Steven Finer, DPM, Philadelphia, PA
03/27/2026
RESPONSES/COMMENTS (OBITUARIES)
From: Nicole Freels, DPM
Our profession has lost one of its most formidable and charismatic figures. To say Hal was a firecracker is an understatement... Hal was the fire and the cracker. He carried a spirit and passion that was undeniable and powerful. It was truly a privilege to be in his presence. When I first met him in 2000 as a student, I was immediately enamored with his enthusiasm and overall vigor for our profession. The amount of sun that radiated from him, and the desire to help literally anyone (and everyone), is to be admired. The gravitational pull he exuded is incredibly rare in our profession.
I recall how nervous I was to meet him and how honored I felt that he even paid attention to little ol’ me. If you know Hal, you know. As per Hal, he immediately took me under his wing. I nearly fell over when he gave me his personal cell and email and encouraged me to contact him as I was building my private practice out of residency, during the Great Recession. I gladly took him up on his offer, and our professional friendship grew. I was one of his “groupies.” However, being a groupie and having access to his brilliance came with one caveat:...
Editor's note: Dr. Freel's extended-length letter can be read here.
03/27/2026
RESPONSES/COMMENTS (MEDICARE)
RE: 80% of Medicare is Not Enough Anymore
From: Farshid Nejad, DPM
To my friends and colleagues out there... If you have contracts or are negotiating new contracts for only 80% of Medicare, then you are being taken advantage of. Some who see Medi-Medi patients feel that it is a good deal because they are getting Medicare rates. YOU ARE WRONG. First and foremost, you are driving down the average reimbursement for all podiatrists when you accept this amount. The data is readily available to all these payers and they use it against us.
But now consider something else. Those Medi-Medi patients have less up-front administrative burden than the managed care plans you are negotiating. Your staff needs to get prior authorizations, you need to worry about share of cost for the patient, cost of sending statements, increasing A/R days because some of these payers contractually hold payment for 30 to 45 days, etc. These costs cut into your margin so you really are not getting 80% of Medicare allowable anymore. DON’T BE FOOLED. Negotiate for the full 100% of Medicare rates. You deserve it!
Farshid Nejad, DPM, Beverly Hills, CA
03/27/2026
RESPONSES/COMMENTS (CAREERS IN PODIATRY)
RE: Why did you decide to pursue a career as a healthcare provider?
From: Allen M. Jacobs, DPM
The recent discussions centering on and focused upon "a good income" leave me with a sense of discomfort. The phrase “medicine is a business" is correct. However, the assignment of medical practice to the category of "just an other profit first and foremost business" is not appropriate, is not in keeping within the spirit of medicine, and may lead to unacceptable ethical and at times legal behavior.
Who was your favorite Hollywood doctor? I always liked Dr. Galen Adams on Gunsmoke. Respected by all. Had a beer or two at Miss Kitty's saloon. Then there was Ben Casey, passionate about care for his patients and confronting ethical dilemmas (although I look and feel more like his mentor Dr. David Zorba these days). I liked him also. But as I aged and witnessed what has now evolved and confronts our young podiatric physicians, as a former residency director, I relate more to Dr. ...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/27/2026
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Joseph Borreggine, DPM
Our esteemed podiatric colleague has once again provided us with a highly insightful response to a query regarding the significance of due diligence even when providing benign services such as routine foot care in long-term care facilities.
For years, podiatrists have provided foot care to the elderly in nursing homes, assuming that the services they offer are considered low-risk and have minimal exposure to potential liability in the context of malpractice. However, this assumption may no longer be accurate.
Dr. Jacobs’ response emphasizes that while podiatrists adhere to the Medicare LCD and routine foot care policies to secure reimbursement based on medical necessity and supporting documentation, they may inadvertently become entangled in a...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
03/26/2026
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Need for a Central Service for Residents to Find Jobs
From: Bruce B. Levin, DPM
There is an issue in podiatry that I do not think garners enough attention, and should be addressed if we are going to help our residents and young associates going forward. The issue is there is no central service or podiatric body to reach all of our residents across the country to tell them about good quality jobs that are available when they complete their residency programs.
Attempts are made through various methods, such as advertising in PM News and other publications, and online services such as Facebook, Instagram, etc. with only some success. When I’m finally able to reach some third-year residents, they are so happy that someone actually is trying to offer them alternative positions other than connections they have made through the residency program or local doctors. I’ve also heard from multiple young associates who are in practice for a few years and are unhappy where they are and would like to have an opportunity to go somewhere else and continue their aspiring career.
I have discussed this in the past with some podiatric leaders and with the APMA, and I’ve even had the opportunity to lecture and discuss this at IFAF conferences in the past few years, but there seems to be no solution, other than random reaching out to some residency directors that I know, and the other methods that I detailed earlier in this letter.
Disclosure: Dr. Levin is a podiatric advisor for Provider Resources.
Bruce B. Levin, DPM, Sun City, AZ
03/26/2026
RESPONSES/COMMENTS (OBITUARIES) - PART 1B
I would like to add my voice to the chorus of those acknowledging Hal Ornstein’s contributions to the profession of podiatry and the greater world. My relationship with Hal dated back to his 3rd year in podiatry school when he was trying to raise money for an OCPM yearbook. When Hal and I left that initial meeting, an idea was hatched that led to the creation of the APMSA Corporate Advisory Board, a Residency Program Corporate Advisory Board and, later, to the AAPPM and its Corporate programs.
The idea of inviting companies to invest in educational endeavors fed Hal's appetite, and what started as an ask for $150 turned into a lifetime of teaching and giving. He will be missed but his legacy of lifting podiatry will keep him alive for those who knew him and everyone else who has benefitted from his important work.
Jason Kraus
03/26/2026
RESPONSES/COMMENTS (OBITUARIES) - PART 1A
From: Jon Purdy, DPM
This was really sad news to hear. I have been a friend of Hal (He preferred that over Dr. Ornstein) for the better part of 25 years. I can definitely say I’m a better person with a better practice because of him. I reiterate everything that has been said about him thus far. He was that special kind of person one feels grateful to have known. There’s just no way to forget him.
My best to his family always.
Jon Purdy, DPM, New Iberia, LA
03/26/2026
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Allen M. Jacobs, DPM
The issue of a higher required malpractice coverage for some providing foot health services in extended or long-term care facilities is an interesting one.
The geriatric patient is the most rapidly growing percentage of the population of the United States. The plaintiff's bar will continue to migrate to this population as an increasingly available new feeding ground for litigation against healthcare facilities and providers caring for the aged. Falls, vascular disease, ulcerations, diabetes, are but a few of the conditions seen in the older patient. The natural history of such disorders not infrequently includes a less than desired end result even with optimal care. Plaintiff's attorneys know that raising the “shoulda, coulda, woulda” hindsight bias, suggesting that more vigilant care would have altered the essential reality of life, nature, and death, may result in...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 2C
From: Robert Kornfeld, DPM
I graduated from NYCPM in 1980 and opened my own private practice in 1982. And shockingly, there was no such thing as managed care. We functioned in an indemnity insurance model. You did your work. You sent a claim form (handwritten, there were no ICD-10 or CPT codes). You got paid 80%. The patient or secondary plans paid 20%. Bunionectomy with osteotomy back then through commercial carriers, for example, could reimburse in the $4-6,000 range.
On 20 patients per day, I ran a financially successful practice. I was happy. Until I wasn't. In the early '90s, if you weren't signed up with managed care, insurance paid much higher out-of-network fees. But little by little, they started drastically reducing those fees and made reimbursements more and more difficult to obtain. And I was losing patients to in-network podiatrists. So I signed up for...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 2A
From: H. David Gottlieb, DPM
In all my years as a podiatrist, I do not recall having, but imagine that I have met Dr. Jacobs, but I have heard only good things about him. In his latest post on the future and standing/prestige of podiatry in today's medical world, he eloquently stated what I have been saying: "You are responsible for your own fate and circumstances."
For my first 20 years, I performed hammertoe, distal bunion, and toenail surgeries. Nail debridements and lots of the old C&C (corns, calluses). My patients were thankful for the relief from pain and the ability to continue their chosen path. Several tracked me down years later to express their gratitude. I could see that this was a pathway to financial reward. Despite what Dr. Jacobs states, a good living can be made performing this vital service IF...
Editor's note: Dr. Gottlieb's extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1
RE: Immediate Need to Address Podiatry’s Future
From: Joseph T. Hogan, DPM
It was my pleasure to attend virtually the St Louis Podiatry Seminar this past Friday and Saturday. The content and presentation of the lectures were excellent. I also found the presentation by Rod Tomczak, DPM, MD, EdD to be very informative. I have been in practice for 50 years. When I began practice in Binghamton, NY, there were two DOs in town who did not have hospital privileges. There were no FNPs and PAs. That has all changed.
I am board certified by ABPM, ABFAS, ABQAURP, faculty of a medical school, faculty of a number of schools of podiatric medicine, and faculty of a family practice residency program. Today, we, as DPMs, and they as DOs, FNPs and PAs all have hospital privileges in significant numbers. The numbers of applicants to our three-year residency program are minimal and in fact threaten the continued existence of our hospital-based residency program.
I believe our profession needs to consider establishing a collaborative study group regarding our immediate future. I recommend that Dr. Tomczak be a member of that body. The future of our profession is now, not five years from now. We need to ensure the continued existence of our specialty. We, as podiatrists, can ensure the future continued existence of our specialty with an enhancement of our degree to include us as a recognized podiatric physician.
Joseph T. Hogan, DPM, Binghamton, NY
03/25/2026
RESPONSES/COMMENTS (OBITUARIES
From: Richard H. Mann, DPM, Bruce G. Blank, DPM
Hal was a truly kind, generous, loving, charitable soul. I am deeply saddened by his passing. The world is a lesser place for it.
Richard H. Mann, DPM
I was shocked and am very saddened by the recent passing of my friend, Dr. Hal Ornstein. He would be so thankful for and humbled by the thoughtful words of his friends and colleagues that have been posted on PM News and on Facebook. The posts concerning Hal were so well expressed and they were messages written from the heart about the type of person Hal was and the impact he had on others. I can tell you that he loved each of you.
He always appeared most satisfied when he was able to help anyone in need. As mentioned by those who’ve known and worked with Hal for years, he received many well-deserved accolades during his career. But what he appreciated most was simply the deep love shared with him by family and friends.
Hal and I first met at OCPM during...
Editor's note: Dr. Blank's extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 2B
From: Elliot Udell, DPM
Dr. Jacobs is correct when he asserts that there are many podiatrists who do Charcot foot surgery, total ankles, and have great surgical and podiatric medical practices and make a lot of money. Let's also focus on the other example he gave. At the dinner meeting he addressed, only four of the 40+ attendees were doing anything more than cutting nails all day.
Our profession's problem is to find ways to increase enrollment in our schools and to ensure that the public will be able to avail themselves of our services not just now, but fifty years from now. Let's be true to ourselves. A pre-med student can choose the route of being an MD, DO, DDS, or a DPM. Since they are putting their lives and future finances on the line, these students will be visiting doctors' offices. How do we make sure that they visit the offices of Dr. Jacobs and his students or the 36+ podiatrists at the dinner meeting who only cut toenails and have empty offices? If we solve this problem, the problem of insufficient applicants at our schools will automatically be solved.
Elliot Udell, DPM, Hicksville, NY
03/24/2026
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Howard Zlotoff, DPM
The management of pain is complex and intimidating with such oversight by the medical community. Having been on the “other side” of pain, suffering from intense nerve pain for many weeks, I developed a much different attitude when my patients needed strong medications to control pain. Acute, severe pain can literally drive a person crazy if not alleviated appropriately.
There are patients that have short duration acute pain that justifies opioid use on a short term basis. I felt comfortable managing these patients. Then there are those patients with conditions that evoke chronic severe pain for extended periods of time. Rather than compromise appropriate care that this type of patient needs, I suggest consulting with a pain management doctor who has the experience and expertise to give this type of patient adequate relief for as long as necessary. This relieves the podiatrist of concern that opioid prescriptions will trigger oversight and possible medical board involvement. Everyone wins. The patient gets pain relief, the podiatrist can find an off-ramp to avoid concern of opioid prescriptions being investigated and let the medical system work as it should.
Howard Zlotoff, DPM, Grantham, PA
03/24/2026
RESPONSES/COMMENTS (OBITUARIES)
From: Lynn Homisak
The passing of Dr. Hal Ornstein – an immeasurable loss. It's hard to add anything to the accolades posted on PM News by Peter Paicos and Bret Ribotsky of Hal’s personality, inspiration, and influence that he so generously and unconditionally gave to everyone in and out of our profession. Together, they captured the true persona that was Hal.
He was a student and I was a podiatric medical assistant when we first met (That was a long time ago!) Unsurprisingly, I was immediately drawn to his enthusiastic attitude and zest for life. Since then, we’ve been through a lot together, culminating in a valued long-time friendship.
I regarded him as my mentor, my educator, a younger “brother”, a scarecrow to my Dorothy, and...
Editor's Note: Lynn's extended-length letter can be read here
03/24/2026
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Joseph Borreggine, DPM
“Long-term care facilities are a tough class to get coverage in…”
If you do not need to change malpractice insurance away from the standard market, then be aware that the sentence above may apply and affect the ability to obtain malpractice and/or the cost of annual premiums when considering providing foot care services in long-term care facilities such as nursing homes.
This statement also highlights the potential issues when considering servicing nursing homes and long-term care facilities. Standard malpractice carriers involved with the podiatric profession do not traditionally have significant concerns regarding this type of...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
03/24/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) -
From: Allen M. Jacobs, DPM
Dr. Smith calls for a unified identity defining podiatry. He and other PM News readers have asked the same question, and bemoan the perceived low regard for, and financial remuneration for the services of, a podiatrist. To quote Cassius from Shakespeare’s Julius Caesar, “the fault dear Brutus is not in the stars, but in ourselves that we are underlings.”
A number of years ago, I was speaker at a dinner meeting on the subject of treating diabetic neuropathy. After 5 minutes or so, it was clear to me there was little interest in the room. I decided to do something I had always wanted to do. I stopped the presentation and told the 40 something podiatrists attending that I wanted to take a survey. I asked for a show of hands. I asked how many in the room treated neuropathy. 2 or 3 people raised their hand. I asked how many did significant hind foot or ankle surgery. 4 people at...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Judd Davis, DPM
Dr. Jacobs states, "These are indeed the best of times to be a podiatric physician. Utilizing Medicare reported RVUs, the average podiatrist should earn a minimum of $269,900 annually." That may be the case for gross income, but certainly not for net income take home pay. Chat GPT and Gemini AI searches both state that the average net pay is around $150K. This is the bottom of the pay scale as far as medical specialties go. Maybe Dr. Block can post the most recent annual survey results for net and gross pay to help confirm these numbers?
I have personally watched my income being eroded away by ever increasing overhead and stagnant unchanging reimbursement from Medicare and most commercial insurances, even witnessing some podiatrists being pushed right out of business for this reason. In 1987, I had B/L matrixectomies done and my parents paid $800 cash, and thought wow, I can help people and make that kind of money. Sign me up. Today, almost 40 years later, Medicare pays...
Editor's note: Dr. Davis' extended-length letter can be read here. To view Podiatry Management's latest poll on income, click here.
03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: James DiResta, DPM, MPH
I appreciate Dr. Jacobs' recent entry and the accolades provided and I couldn't agree more. The profession of podiatry has come of age and podiatrists are in a better and more envious position today than ever. I know as I experienced these last 40 plus years and I can only look back with gratitude on what collectively we have accomplished. But we have a problem. A very big problem and it couldn't be more obvious to anyone who has been involved in graduate medical education and it should be obvious to our profession as a whole. Calling the problem transient is delusional and won't fix it. Marketing won't fix it.
Our student applicant pool is dwindling and the strength of that pool is, well, let's just say it's lacking. If you don't see it, go and look at the numbers yourself and when you can't find all the numbers (trust me nobody in authority is releasing them), ask yourself why? Call. Request them in writing. What you'll get is bits and pieces at best and you'll start to see that something is not right. This pattern of acceptances is going to catch up with us. TUSPM, one of our jewels, had matriculant MCAT scores of 500 just ten years ago and that has gone down to...
Editor's note: Dr. DiResta's extended-length letter can be read here.
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