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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:
07/16/2026
RESPONSES/COMMENTS (DME) - PART 2
RE: WISeR Follow Up and AI
From: Paul Kesselman DPM
Since my last post on the House Appropriations Committee action on the WISeR program, the House Committee did in fact move forward with an amendment which would block further Federal funding for the program. Most recently, Virtix, the WISeR vendor in Washington State, who depends on AI to approve or deny prior authorizations, was cited having failed multiple audit subjects across five areas of complaints. This ultimately led to the WISeR program being unable to meet the 72-hour turnaround time. CMS has ordered the AI vendor to submit a Corrective Action Plan. How this may impact your claims and other WISeR models is still unclear.
If your Prior Authorizations are not sufficiently resolved (either approved or denied), you should report these incidents to your local and regional Medicare office in your MAC.
Paul Kesselman, DPM, Oceanside, NY
07/16/2026
RESPONSES/COMMENTS (DME) - PART 1
From: Gary S Smith, DPM
I had a similar issue. My staff made some minor mistake on our re-application. We didn't find out until we were denied DME claims. She had fixed the mistake in time and there were no mistakes. They told us they were "still processing it". This went on for months. It started in May. In September, we contacted PICA because they cover things like this. The lawyer thought it was a big joke and did nothing. All I got was a huge increase in my PICA premiums.
Finally, in January, we contacted our congressman. In about 2 weeks, the ball got rolling and our re-application was approved. They did pay for the denied claims from over the previous year. I imagine they will pay for your claims made after you re-applied but not in between lapses. You can bill the patients.
Gary S Smith, DPM, Bradford, PA
07/16/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: David S. Wolf, DPM
Kudos to Dr. Gary Dorfman on podiatric identity. As one of the older members of our profession, this post truly resonated with me. When I entered podiatry school nearly 60 years ago, I confess that I carried a degree of professional insecurity. Our profession was still working to earn its rightful place within the medical community. There were only 5 or 6 one-year internships/residencies. We were relegated to performing foot surgery in our offices, as surgical privileges in hospitals were unattainable.
Looking back, it has been a privilege to witness the remarkable evolution of our profession. As Dr. Dorfman posited, “podiatrists are highly trained physicians and surgeons who play an essential role in limb preservation, diabetic care, sports medicine, reconstructive surgery, and multidisciplinary healthcare.” Thankfully, we have come a long way baby. All of the discussions and angst about parity, plenary licensing, student debt, and decreasing enrollment in our schools are real but…
07/15/2026
RESPONSES/COMMENTS (PODIATRIC ECONOMICS)
Ivar E. Roth, DPM, MPH
Dr. Jacobs is correct about the earning potential of podiatrists. The private practice model, especially the single practitioner, is doomed for extinction. The only model left for private practice is the niche concierge or direct pay model which I have advocated for others to consider. I must say that after all these years of practice, it is only getting better and stronger as a model now; I have been direct pay for over 25 years. There is hope but it takes time and hard work.
Ivar E. Roth, DPM, MPH, Newport Beach, OH
07/14/2026
RESPONSES/COMMENTS (PODIATRIC ECONOMICS)
from: Allen M. Jacobs, DPM
Thank you Dr. Hrywnak for your contributions to our understanding of the evolving medical care milieu. Your discussions are of course greatly appreciated. The new issue of JFAS contains a study concluding that over the last 25 years, real dollar reimbursement for surgical procedures has declined over 49%! This is hardly news to those who have been in active practice over this period of time. Alternatively, a recent ACFAS study indicated that podiatrists doing 500 or more procedures per year have an average annual income greater than $1,000,000.
With that said, there is additional value to performing surgical procedures from a financial viewpoint. That is, your value to the healthcare system goes beyond your reimbursement for a procedure completed. One of my close friend’s son is a recent osteopathic college graduate. His starting salary for primary care practice was over $400,000. One of his close friends, a DO completing a cardio-thoracic fellowship, received a starting offer of $1,200,000. Another, a DO finishing his general orthopedic residency, is starting at...
Editor's note: Dr. Jacobs' extended-length letter appears here.
07/14/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE) - PART 2
From: Gary Dorfman, DPM
Do you practice osteopathy or are you a chiropractor or naturopathic practitioner? No? Then what type of medicine do you practice? Does ALLOPATHIC sound familiar? It absolutely amazes me why any podiatrist would denigrate his or her DPM degree from a podiatric institution and state to anyone, "when I graduated from MEDICAL school". Sound familiar? What is there to be ashamed of? Who are you trying to impress? Are you kidding yourself?
You are a podiatrist. Your degree is DPM. You graduated from a podiatry school or college. You have a bachelors degree, four years of podiatry school, and a three-year podiatric residency. You know more about your chosen field of practice than any other medical practitioner. Why in the name of heaven wouldn’t you be proud of that?
In my fifty-five years of active practice, our profession has advanced from the treatment of just corns and calluses, ingrown nails, and dispensing of arch supports to being the leaders in functional orthotics and biomechanics, surgery for total ankle replacement, pioneers in the treatment of diabetic ulcers, and limb preservation. Let us stand tall in our professional and personal achievements and recognize our contribution to the medical establishment!
Gary Dorfman, DPM, Dana Point, CA
07/14/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE) - PART 1
From: Bret M. Ribotsky, DPM
Drs. Jacobs and DiResta both make points worth taking seriously — self-respect in how we describe our training matters, and so does the substance of that training. But I think the debate itself, as framed, is a distraction from the problem we’re actually trying to solve. Here is the uncomfortable truth: it doesn’t matter what we call ourselves. What matters is what the market we’re trying to influence calls us, and what that market believes we are.
That market is not us. It’s the high school and college students deciding whether podiatry is a viable career. It’s the hospital administrators deciding whether to grant privileges, build out a service line, or hire a DPM onto a surgical group. It’s the insurance companies deciding how to code and reimburse what we do. Their perception is the only one with commercial and...
Editor's note: Dr. Ribotsky's extended-length letter appears here.
07/13/2026
RESPONSES/COMMENTS (PODIATRIC ECONOMICS)
RE: Why have podiatrist’s surgical fees decreased over the past 10 years?
From: Sev Hrywnak, DPM, MD
Doing surgery is not the financial answer.
Payer pressure and cost containment
*Private insurers and government programs have pushed for lower reimbursement rates for procedures, often through fee schedule updates and value-based contracts.
*Global budgeting and utilization controls in some regions limit total spending, compressing per procedure fees.
Shift to value-based and bundled payments
*Bundled payments for episodes of care incentivize cost efficiency, which can reduce the negotiated amount paid per surgery as part of a total-care package.
*Emphasis on outcomes and standardized pathways tends to favor predictable, lower per-procedure fees over high, variable...
Editor's note: Dr. Hrywnak's extended-length letter appears here.
07/13/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE) - PART 1B
RE: Podiatric Medicine is Allopathic Medicine (Allen M. Jacobs, DPM)
From: James DiResta, DPM, MPH
I found Dr. Jacobs' comments concerning our DPM degree spot on. We really ought not to be ashamed of our degree. Our degree today is far more respected than it was when I completed my podiatry training. The issue of whether our students are medical students or not is an important question that we wrestle with and I'm sure depending upon when you finished podiatry school might influence your response. I have always felt the didactic education and clinical rotations I completed at PCPM were on par with the medical and osteopathic students that I encountered on my rotations. I did feel intimidated at times on medicine rounds with some of them but often felt pretty good about myself and my training when compared with others.
I dug up a couple of my name badges from my rotations at Metropolitan Hospital recently from back in the day. After asking myself where did all that nice bushy hair go, the wording on the badge is medical student. I always felt that I was a podiatry student but...
Editor's note: Dr. DiResta's extended-length letter appears here.
07/13/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE) - PART 1A
RE: Podiatric Medicine is Allopathic Medicine (Allen M. Jacobs, DPM)
From: Ivar E. Roth, DPM, MPH
Dr. Jacobs is correct. We should be proud of our degree. My simple answer when people ask where I went to medical school is I went to podiatric medical school at ..., or a went to podiatric medical school. I also explain that I am a podiatrist, board certified in foot and ankle surgery. I do not go into details about ABFAS but if someone wants further information, I explain the difference between being board certified in surgery and being board certified in podiatric medicine.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
07/13/2026
RESPONSES/COMMENTS (AI)
RE: AI Documentation
From: Jeff DeSantis, DPM
After practicing podiatric medicine for more than 30 years and utilizing virtually every charting modality—from dictation and Dragon to human scribes. I was recently asked by my longtime colleague and close friend, Dr. Michael King, to evaluate AizaMD, an ambient AI documentation platform developed by SARC MedIQ. During that time, I've witnessed tremendous advances in our profession, but very few technologies have changed my day-to-day practice as quickly or as profoundly as ambient AI documentation.
Like many of my colleagues, I approached this technology with a healthy dose of skepticism. I questioned whether artificial intelligence could accurately capture the nuances of a patient encounter without creating more work than it saved. Before implementing it, I had several conversations with the company's physicians, Stanford-trained PhDs, and development team. They welcomed physician feedback and worked closely with me to further tailor the platform to the unique needs of...
Editor's note: Dr. DeSantis' extended-length letter appears here.
07/10/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: Allen Jacobs, DPM
And you want to know why there is a recruitment problem? Why people do not know what a DPM is? What they do?
Allopathic medicine? Of course we practice allopathic medicine. It is a Strawman argument to suggest that only an MD can practice allopathic medicine. By the way, don’t raise that Motte-and-Baily question to the DO who must complete a mandatory course in osteopathic manipulation technique. There are multiple DOs I know who practice osteopathic manipulation techniques.
Maybe, just maybe, if YOU did not engage in the self-deprecation and devaluation of your DPM degree, and concentrated instead on demonstrating a level of clinical, academic, and ethical excellence associated with the DPM degree, some of the issues debated in PM News would be resolved without the constant use of equivocation or red herrings.
When you begin a discussion by stating, "When I graduated medical school,” you assert a foundational, “I am ashamed that I graduated a podiatric medical college or college of podiatry." It is a form of deception, self-deception as well as self-deprecation. If you do not respect yourself, why do you expect others to respect you. Otherwise, sing a chorus of Masquerade from Phantom, because that is what you are doing.
Allen M. Jacobs, DPM, St. Louis, MO
07/09/2026
RESPONSES/COMMENTS (OBITUARIES)
I was also sorry to hear about the passing of Dr. Kay Hara. He was one of the early doers promoting podiatry in California when I was a student at OCPM over 60 years ago. The profession will miss him and so will I.
Steven Berlin, DPM
07/09/2026
RESPONSES/COMMENTS (EQUITY BUY-OUTS)
RE: Are Large Groups Calling Your Office Asking You to Sell?
From: Sev Hrywnak, DPM, MD
Due Diligence Checklist for Podiatric Physicians
1) Deal Structure and Valuation
* Ownership vs. management-only model: current stake and post-transaction ownership.
* Earn-out mechanics specific to podiatry metrics (e.g., procedure mix, surgery volumes, implant reimbursements).
* Valuation basis: surgical margins, implant costs, managed care mix, diabetic foot care volume.
* Exit provisions: buy-backs, partial exits, tail revenue streams (e.g., post-op follow-ups).
2) Governance and Control
* Board composition and physician seats; reserved matters (clinical protocols, implant purchases,...
Editor's note: Dr. Hrywnak's extended-length letter appears here.
07/09/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: Allen M. Jacobs, DPM
Self-denigration or self-devaluation is the undervaluing of yourself, your status, your achievements. Self-devaluation or denigration is when you refer to yourself as having graduated "medical school". That is self-denigrating your own education. Self-denigrating is hiding your DPM degree. By this very action you establish that you are ashamed of your degree. You devalue your education and degree. You feel less than respected for all that you have accomplished as a healthcare provider.
I want the DPM degree respected. I wish to be respected as a DPM. I desire the colleges of podiatry and subsequent residency and fellowship training to be respected for providing society with competent individuals to evaluate foot and ankle pathology, from onychomycosis to...
Editor's note: Dr. Jacobs' extended-length letter appears here.
07/08/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT)
RE: Podiatrists Feed their Young: An Innovative Solution
From: Rod Tomczak, DPM, MD, EdD
We’ve batted around degrees, curricula, and recruitment for the last couple of years without resolve. For the most part, we’ve done a great job criticizing but all the education experts in podiatry have shied away from the most important crisis on the doorstep. Where are the students going to find the money to earn one of the gold Doctor of Podiatric Medicine diplomas?
There is a solution, but it will take a leap of faith, teamwork, including APMA, the colleges, and our uber-successful private practitioners to remedy the predicament. Granted, the mention of APMA is usually an impediment by itself, but this is a chance for our Washington friends to serve as both an arbitrator and fixer to help ensure the future podiatrists are not eaten alive; something foreign to both the APMA, the colleges, and those practitioners who keep the banks open. It’s also a chance for all the Luddites who fear any changes in podiatry to step up and put their wallets where...
Editor's note: Dr. Tomczak's extended-length letter appears here.
07/08/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: Lawrence Oloff, DPM
The debate continues over a plenary degree, the end of podiatry, student recruitment, etc. There are certainly a lot of armchair generals weighing in on a solution. Many have good points to make and I do not want to make light of those. However, very rarely is a bright light comment made on chiropody in these posts. Dr. Jacobs did an excellent job highlighting the changes that many of us have observed on a prior post about podiatrists who are faculty in medical schools, leaders in wound care, the complex surgeries that residents are taught, and so on. Show your board certification credentials and the operating room is yours to practice in, just like any area of medicine.
I think of podiatry as a premier medical profession to enter that is just not marketed correctly and remains mostly unknown to potential students. Does the answer lie in making a cheaper pathway? Maybe. But I think many of the advancements of podiatry are due in part by following the structure of...
07/07/2026
RESPONSES/COMMENTS (NATIONAL PRACTITIONER DATA BANK)
RE: It's Time to End the National Practitioner Data Bank (NPDB)
From: Richard B Willner, DPM
The National Practitioner Data Bank (NPDB) is a 20-year experiment created by an act of Congress along with the Health Care Quality Improvement Act of 1986 (HCQIA). The experiment has failed. It is time to abolish this agency. The NPDB is a blacklist reminiscent of the McCarthy blacklist of the 50s. Instead of targeting the Red Menace, or Communists, the target of this blacklist of the White Menace: “Bad Doctors.”
The problem is that too many good doctors’ names are submitted to this list. And it is disturbingly easy to do. The perception is, if a doctor is included on this list, they must be a bad doctor; otherwise, why are they on the list? The consequences of a listing are dire. As a result of a listing in this “data bank”, many doctors become unemployed and unemployable. For surgeons who must use a hospital operating room, the “data bank” is as permanent as a...
Editor's note: Dr. Willner's extended-length letter can be read here.
07/07/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
RE: Podiatric Medicine is Allopathic Medicine
From: David Secord, DPM
I'd like to comment about 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 a few others. Allopathic medicine has as its basis the idea of pathology from disease state: bacteria, virus, prion, spirochete, genetic dyscrasia, etc. Unless I missed something critical in medical school, that’s the disease model we in podiatry follow as well. As such, podiatric medicine is allopathic medicine. Allopathic is not a synonym for "MD"; allopathy is a medical theory and one our profession follows.
Podiatry is often stated as wishing to compete with "allopathic" providers in the area, as if WE were not allopathic physicians. One of the myopic tendencies in our profession is to separate ourselves in like manner from allopathy, which makes no sense to me. Podiatry follows the allopathic theory of medicine. We ARE allopathic physicians and referring to ourselves as podiatric physicians with similarities to allopathic physicians (as if allopathy means "MD", which it obviously does not) shows either ignorance of what the term means or is a strange form of self-denigration I don't understand.
David Secord, DPM, McAllen, TX
07/07/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT)
From: Paul Stepanczuk, DPM
Regarding the letter from Carl Solomon, DPM and the worries about following all the rules from the multitude of ruling bodies, Medical Economics magazine about 25 years ago published with the cover (paraphrased): We looked at all the rules you now need to follow. We concluded you have already broken one or many of them, so just keep going and do your best.
Paul Stepanczuk, DPM (Retired), Tinley Park, IL
07/06/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1B
From: Jon Hultman, DPM, MBS
Dr. Solomon makes a compelling argument regarding all of the aggravating factors that make practicing medicine and surgery less enjoyable than in past years. That being said, I do not believe that this explains the podiatric recruitment crisis. Every MD and DO physician experiences the same kinds of aggravation while practicing medicine; however, MD and DO medical schools are not experiencing the same decline in the number of applicants.
There are 142 specialties and subspecialties of medicine that are recognized by the American Board of Medical Specialties (ABMS). Our specialty is the only one that trains for seven or eight years that does not receive the same plenary license that every other specialty receives. While there may likely be many lesser factors affecting applications, I strongly believe that graduates receiving the same limited license I received in 1970 is likely the major reason for the decline.
Jon Hultman, DPM, MBS, Los Angeles, CA
07/06/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1A
RE: The Most Radical Proposal Yet
From: Rod Tomczak, DPM, MD, EdD
To save the profession I think it’s necessary to cater to the consumer. The first consumer is the student. What keeps us from offering a completely different curriculum at each of the schools, allowing the potential student the opportunity to choose the path he or she will best benefit them? The quick and dirty answer is CPME? There may be CPME members with academic titles, but there are no dedicated educators with hands-on, contact, advanced education degrees in philosophy, methods, or curriculum.
Let’s say the New York College wants to offer the traditional four-year DPM degree to the students with a bachelor’s degree and emphasizes the current three-year residency. They fine-tune their curriculum to complete that mission and advertise their unique plan in a universal advertisement that will describe all the schools’ programs. All the schools. All the schools together in one advertisement. Unity will not only save money but...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
07/06/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS)
RE: The Economic Value of Being an Associate
From: Sev Hrywnak, DPM, MD
Here’s why spending $400,000 (undergraduate and graduate) on medical education might not make economic sense if you only end up as an employee.
1. Opportunity costs and expected return on investment (ROI)
The upfront cost of medical education is substantial: tuition, fees, living expenses, and time out of the workforce. If the career path ends with employment, the long-term financial upside may be limited by a capped salary, promotion pace, and limited ownership opportunities. Opportunity cost analysis compares the present value of potential alternative careers (or entrepreneurship) against the guaranteed but potentially modest salary path.
2. Salary growth and lifetime earnings uncertainty
Early-career salaries for medical graduates can be solid, but long-term growth depends on...
Editor's note: Dr. Hrywnak's extended length letter appears here.
07/04/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1C
From: Bret Ribotsky, DPM
Since my letter on the podiatric enrollment crisis appeared in PM News, I have received a meaningful volume of private correspondence from colleagues across the profession — practitioners, educators, and organizational leaders. I am grateful for the engagement. The responses were thoughtful, and several came from individuals whose standing in this profession I genuinely respect. Because they were shared privately, I will not attribute them by name, but I believe the arguments they raised deserve a public answer, because they reflect exactly the kind of institutional thinking that I believe is preventing this profession from moving forward.
The responses I received shared a common architecture. Each acknowledged, to varying degrees, that the economics are real, that student recruitment is suffering, and that the profession has struggled with unclear messaging about its identity. And each, having made those acknowledgments, arrived at the same conclusion: the answer is a ...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
07/04/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1B
From: Elliot Udell, DPM
Dr. Solomon makes a valid point. The practice of medicine is inundated with hassles and they come from every angle and almost every day. When I started podiatry school back in the 1970s, my uncle was nearing retirement from his practice in general medicine. He cornered me and gave me stern advice. He said, "Elliot, the only two things you have to offer a patient are your time and your knowledge."
Today, as Dr. Solomon so eloquently stated, doctors are inundated with all sorts of paper and computer work, as well as being accountable to numerous government agencies and, of course, the insurance companies that are paying us less and less every day. This is why so many MD and DO practitioners as well as new graduates are opting to work for corporations and hospital-owned practices. Unfortunately though, when working for these corporate entities, doctors find they sold themselves to "the devil". No hassles, but less time can be spent with patients.
Elliot Udell, DPM, Hicksville, NY
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