|
|
|
|
|
Search
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:
09/17/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Rod Tomczak, DPM, MD, EdD
Dr. Bisbee is an expert at the hidden ball trick and passing responsibility for the decision to tell ACGME that the podiatry profession was not interested in having their residencies accredited by the ACGME of medical accreditation organizations. In the second paragraph of her letter, she says, “In recent weeks we had meetings with many stakeholders within the profession to discuss the pros and cons of participating in an exploratory process with ACGME.”
First, the word “secret” was omitted between the word “had” and the word “meetings” in the quoted sentence. Second, it’s amazing how the hoi polloi of this profession are conveniently forgotten concerning what is going on. Mushroom theory of leadership again. Third, ACGME’s offer is an exploratory look/see at the educational process involved in accreditation of our own programs. It’s not like we are turning over Rome to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/17/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: James DiResta, DPM, MPH
If podiatry is ever to gain parity with MD/DO colleagues, we are going to need comparable educational training and one very important component to that end is recognition of our residency programs by ACGME. APMA could argue that this is putting the cart before the horse but the importance of this discussion by APMA representative stakeholders rejecting the ACGME invitation is a lost opportunity. The "laser focus" excuse given is just simply absurd.
Where the heck are the leadership's priorities? Are you going to wait until HOD meets again next year? I thought we had an alternative pathway when issues of this magnitude needed to be decided outside of that timeline.
James DiResta, DPM, MPH, Newburyport, MA
09/17/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Mark Light, DPM
You can check with Frankford Leather Company in Bensalem, PA
Mark Light, DPM, Marietta, GA.
09/17/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Doug Richie, DPM
I appreciate the comments made by Dr. Kesselman regarding the role of the podiatric physician in preventing falls in elderly patients. However, I am confused by his statement "Prescriptions and orders for AFO and walker will no doubt fail if the primary reason for the patient's fall risks are not properly addressed."
I am not aware of any studies which verify that an AFO or a walker will prevent falls in non-neurologic impaired patients. Furthermore, I am not aware that addressing "the primary reason for the patient's falls risk" is somehow a requirement which could possibly justify reimbursement for AFOs and walkers specific to the medical necessity of falls prevention? Perhaps Dr. Kesselman can explain the advice he provided in his post?
Doug Richie, DPM, Long Beach, CA
09/17/2025
RESPONSES/COMMENTS (MEDICARE)
RE: MMSEA 111
From: Paul Kesselman, DPM
CMS in its infinite wisdom has announced a new acronym MMSEA 111, Medicare, Medicaid, Schip, Extension Act of 2007, Section 111. This new policy should alert you that you must report incidents where you can identify payments which should not have been paid by Medicare but rather by another carrier. That is Medicare should have been the Secondary Carrier as the patient may have been covered by another entity.
While this is not really a new policy, the heavy handedness and penalties soon to go into effect are really incredible. One example, is that effective January 1, 2026, CMS will be conducting random audits going back to the first date of...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/16/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Andrew J. Meyr, DPM
Well it's Groundhog Day...again. Another year and apparently we're in for Dr. Rogers leading another disruptive charge at the APMA HOD and another thinly veiled attempt to undermine the CPME.
One of the things that Dr. Rogers didn't disclose in his post is that not only does the APMA Board of Trustees have reservations about his most recent strategy...and make no mistake he was the driving force behind this...but also AACPM, COTH, CPME, ABFAS, ACFAS and several state societies. These are groups that perform due diligence and try to consider all potential ramifications of decisions for their members and the profession, and don't simply act on superficial reactionary public perception. I would encourage PM News readers to review the actual statements from APMA and CPME on the topic, instead of only Dr. Rogers' "Rejects" attempted...
Editor's note: Dr. Meyr's extended-length letter can be read here.
09/16/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Edward F. Szabo, DPM
On the surface, it is disheartening to hear that the APMA has rejected the ACGME's offer to serve as the credentialing body for graduate (residency) training in podiatry. I have extensive ACGME experience and think they would preserve the integrity of our training and profession.
It is clear to many of us and any potential applicants that do a minimal amount of research that our profession has problems with graduate training standards and post-graduate credentialing. This directly impacts the ability or financial stability once you begin practice. There are too many residencies not providing adequate surgical exposure. There are too many post-graduate credentialing bodies (Boards). ACGME would help create a recognized and unified standard within the profession.
I recognize that the devil is in the details, and am certain Dr. DeHeer and the APMA want what is best for the profession. Still, I would like to know why the ACGME offer was rejected, when it seems like an obvious step forward for the profession.
Edward F. Szabo, DPM, Evans, GA
09/16/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: Brook Bisbee, DPM
This summer, APMA became aware that the Accreditation Council on Graduate Medical Education (ACGME) has interest in exploring accreditation of training programs outside allopathic and osteopathic medicine. This interest is part of ACGME’s business plan to explore extending their accreditation programs to a variety of other healthcare professions.
After an initial discussion with ACGME, APMA shared this information with the leadership of its component organizations and with the leadership of other large podiatric organizations with a stake in residency training including CPME, AACPM, COTH, ABPM, ABFAS, and ACFAS. In recent weeks, we held meetings with many key stakeholders within the profession to discuss the pros and cons of participating in an exploratory process with ACGME. We also gathered written feedback from stakeholders. The feedback was shared with our Board...
Editor's note: Dr. Bisbee's extended-length can be read here
09/16/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Bob Smith, DPM, MSc, RPh
I would like to thank and applaud Dr. Kesselman for his communication centered on the increased risk of fatal falls. I also encourage all medical professionals to not only explore these recent suggested literature sources. Twenty-five years ago, I started researching and developed a narrative that was published as: Smith RG. Fall-contributing adverse effects of the most frequently prescribed drugs. J Am Podiatr Med Assoc. 2003 Jan-Feb;93(1):42-50. The foremost reason, the purpose of this narrative was to document the possible plausibility and causality of medication inducing adverse effects. Given the advances in technology, leaders in our profession indicate that podiatrists should be the leading professionals to identify and prevent falls among our most vulnerable populations.
In July of 2025, I began a systematic literature review to obtain actual statistics and numbers of medications that induce fall injury. I have obtained a...
Editor's note: Dr. Smith's extended-length letter can be read here.
09/15/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Frank Louis Lepore, DPM, MBA
I am deeply disappointed and angered by the American Podiatric Medical Association’s (APMA) decision not to engage in dialogue with the Accreditation Council for Graduate Medical Education (ACGME). This choice does not serve the best interests of the podiatric community and risks undermining years of strategic efforts in gaining parity and Board unification of podiatry.
Our profession has worked diligently to achieve parity with our MD and DO colleagues—working with their organization on common ground in the interest of our professions, expanding applicant pools to podiatric medical schools, investing in targeted marketing, and advocating for broader recognition. These initiatives were designed to elevate the visibility and credibility of podiatric medicine. Without collaboration with ACGME, these resources may be better spent elsewhere or may not achieve the intended return on...
Editor's note: Dr. Lepore's extended-length letter can be read here.
09/15/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
ACGME, the accreditation agency for MD and DO residencies and fellowships has invited podiatry into their fold and become the accreditors rather than CPME. Accreditation by ACGME would mean podiatry is officially a specialty of medicine, just like orthopedics or internal medicine. APMA has voted not to accept the ACGME invitation.
When I attended OCPM, we had the opportunity to enjoy a few high quality MD instructors from Case Western Reserve University. One of them was an anesthesiologist who taught pharmacology to the medical students at Case. He constantly munched on Sen-Sen breath mints and challenged anyone who wanted to play racquetball for a dollar a point. I took the dare and lost my weekly allowance. We had a couple of beers after the game and he told me that after WWII, Case offered to assimilate OCPM into the...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/15/2025
RESPONSES/COMMENTS (OBITUARIES)
I am truly saddened to hear of the passing of one of my ex-residents. I have graduated scores of residents through the years. Some of them stand out more than others. Russell was one of those residents who will be remembered for his kind nature and his graciousness. He was a man who never had a bad word to say anybody and always had a smile on his face. My sincere condolences to his family. Rest in peace Russell.
Steven Spinner, DPM
09/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Keith L. Gurnick, DPM
Frustrating as it may be, there are still some medical specialists who are so full of themselves that they feel comfortable giving patients mis-information on topics where they have little expertise or experience. In the world of custom prescription foot orthotics, this is also commonplace. Trying to educate these "experts in everything" is a noble effort, but I prefer to pick and choose my battles and fight the battles I know I can win. I would rather spend my time educating my patients than educating the doctor who probably made a quick off-the-cuff remark anyway.
Patient education should have been done in advance, not retroactively when the concern or complaint was presented. Regarding a refund. If a patient wants their money returned, the reason is inconsequential. I would give the money back; it happens so infrequently it does not matter. If the orthotics have already been dispensed, I would first get the orthotics back, and if they have not been made, I would cancel the order. If they have been made but not dispensed, I would pay the lab fee, and I now have a brand new unused set of orthotics to show the next patient what a custom prescription foot orthotics looks like.
Keith L. Gurnick, DPM, Los Angeles, CA
09/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Increased Risk of Fatal Falls
From: Paul Kesselman, DPM
A recent article in September 7, 2025 NY Times entitled "Why Are More Older People Dying After Falls," is a must read for every physician, no matter their specialty. The NY Times article points out a three-fold increase in fatal falls over the last thirty years. This compared to a decreased or steady number of fatal falls per capita in other countries.
The reason cited by both the NY Times and its source is the increased reliance on Fall Risk Increased Drugs (FRID) in the U.S. JAMA News while a much lengthier read, provides a substantial amount of statistical analysis and is the foundation of the findings cited in the NY Times article..
Having no other motive but to decrease falls in our most fragile patients, it is imperative to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/13/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
RE: APMA Rejects ACGME Task Force
From: Lee C. Rogers, DPM
It is very disheartening to hear that the APMA has rejected the Accreditation Council for Graduate Medical Education (ACGME) invitation to have a discussion about accrediting podiatry residencies and fellowships as a "specialty of medicine." There are so many possible benefits in becoming accredited with ACGME, recognized as the gold standard in medicine which accredits all MD and DO specialty training.
The DOs joined ACGME in 2014, and in the decade following, there was an increase in DO students by 70% and their profession grew by 81%. Yes, there are still many questions, but refusing to participate in the due diligence process to get the questions answered does not serve the profession well. This should be brought to the House of Delegates to decide.
Lee C. Rogers, DPM, San Antonio, TX
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1D
From: Burton J. Katzen, DPM
When I was in practice and was confronted with this problem comparing orthotics/Hyprocure to store bought arch supports, I would try to educate the patient in layman's terms the difference between pronation and simple flattening of the arch, telling the patient that the majority of the problem was not the height of the arch, but the amount of abnormal motion that occurred when the foot beared weight.
I would demonstrate this by forcefully "shoving" my fist into the patient's arch and showing that I could still easily pronate/evert, or in their words, "flatten" the foot from the sub-talar joint, imitating what an arch support did. I would then lock in the heel with just my thumb to show that I could no longer pronate the foot to demonstrate the difference in control.
I also would never knock a store-bought orthotic telling the patient that, "Hey, The reason Dr. Scholl was rich is because store-bought arch supports do work for many people just like store-bought readers do work for some patients, but other patients need professional care." Also, in my experience, most of the patients I came into contact with had already tried the store bought orthotics.
Burton J. Katzen, DPM (Retired), West Pam Beach, FL
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: David S. Wolf, DPM
I can understand your frustration—and fortunately not very common. When I was in practice, I would have taken the high road in these situations and re-focus the conversation on patient education. I explained the purpose of the custom orthotics, the biomechanics involved, and why we recommended them based on their specific foot structure and pathology.
If they’re still not receptive and demanding, I would make a refund. For every one non-compliant patient, there were too many to count compliant patients. Ultimately—is the time, energy, and potential negative review worth the fee? And most importantly, I wouldn't let one orthopedist's opinion shake your confidence in the value of what we do.
Sometimes, it’s just better to give a refund and move on to the next treatment room. Say to yourself before you walk in, "It's showtime"-and make that patient feel like they are the only patient you have. Patients don't care what you know, they just want to know that you care (Bernie Hirsch, of blessed memory).
David S. Wolf, DPM, retired
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Dieter J Fellner, DPM, Ivar E. Roth, DPM, MPH
Custom orthoses cost hundreds more than OTC devices, and current evidence shows they don’t correct bunion deformity and are not superior to pre-fabs for most common foot pain. However, that doesn’t make them “bogus.” Orthoses can reduce pain and plantar loading, and custom devices are appropriate for patients with complex foot structure or failed OTC trials. For early bunions with over-pronation, they won’t reverse the deformity, but they can reduce symptoms and mechanical stress—which is a valid treatment goal. Our job is simply to match the level of support to the patient’s needs, not to oversell either option.
I guess the question, then, is what unique biomechanical findings does the patient have, to warrant the added expenditure?
Dieter J Fellner, DPM, NY, NY
I would call up the orthopedist and make an appointment to go speak to him. Here is a way to turn a lemon into lemonade. In this meeting, explain what you are doing and why it is preferred to an OTC insole. Hopefully, you can get him to send to you all of his foot patients who need orthotics. It is certainly worth the effort in my opinion. Or make a pair for him gratis. I recently made a pair for an orthopedist in town, and now he sends me ALL his orthotics that he was sending to Hanger.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
09/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Carl Solomon, DPM, Bret Ribotsky,, DPM
My response has always been that custom orthotics vs. off-the-shelf are akin to prescription eyeglasses vs. "readers' purchased at the drug store. I told patients that it probably wouldn't hurt to try the OTCs and occasionally with a little luck, they may help some. But although there are no guarantees, the custom orthotics (like prescription eyeglasses) are more likely to be effective since they are custom-fabricated to address a specific problem. In actual practice, it hasn't really happened but If a dissatisfied patient elects to change their mind and cancel them before lab fees are incurred, I suppose I'd give them a refund. Otherwise, if based upon someone else's criticism alone, I would not.
Carl Solomon, DPM, Retired, Dallas, TX
This is an incredible opportunity to turn lemons into Limoncello. I dealt with this often when I first started practicing a long, long time ago. What I would always do is call the orthopedics office, set up an appointment to either meet him for breakfast or dinner, and spend the time to show him how custom biomechanical orthotics can reduce the pain in a patient’s knees and prolong his knee replacements and hip replacement by realigning the forces. Every time I did this, I was able to generate an additional 20 to 50 pairs of orthotics a year from each orthopedist.
Bret Ribotsky, DPM, Fort Lauderdale, FL
09/11/2025
RESPONSES/COMMENTS (MEDICARE iSSUES)
RE: Flat Rate Payments for CAMPs
From: Paul Kesselman, DPM
As every medical professional seems to understand, CMS has put their stamp on the need to radically curtail spending on cellular tissue products. While this is laudable, a recent article in the Journal of Wound Care, entitled "Safeguarding access, fiscal responsibility and innovation: a comprehensive reimbursement framework for CAMPs to preserve the Medicare Trust Fund" with headlined authors including our own David Armstrong, DPM and Vicki Driver, DPM points out that "An analysis of 2,023 Medicare claims data demonstrated that 26% of total cellular, acellular, and matrix-like products (CAMPs) spending came from just the top 10 providers in non-facility settings, compared to only 5% in facility settings. When expanded to the top 100 providers, the disparity becomes even more pronounced, accounting for an astounding approximately 64% of non-facility spending versus just 19% in the facility setting.
To put this in perspective, fewer than 3% of non-facility providers billing for CAMPs applications are responsible for 63.9% of all CMS spending in this category, while the remaining 97.3%...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/10/2025
RESPONSES/COMMENTS (STUDENT ENROLLMENT)
RE: Admissions Update
From: Rod Tomczak, DPM, MD, EdD
Here we are almost to the middle of September and we have no report from AACPM on total admissions. You would think by now that the class size for each of the schools is solidly established. White coats have been distributed, and ethical administrators have led the classes in the Hippocratic Oath. But no, that is not the case. I contacted some of the schools and asked what the class size for the class entering in 2025 was. A number of schools sent me admissions material, even though the official date for applications is later in the Autumn of 2025 for the class entering in 2026. One school answered the number of students was, “in flux.” Imagine that.
What does that mean? Let’s suppose that you applied to podiatry school to enter now, late summer of 2025, and were rejected. It could be for a low-grade point average or test scores. You could now suddenly receive a “do-over letter” where the school re-considered your application and now after extensive re-evaluation by the dean and treasurer, you can now...
Editor's note: Dr. Tomczak's extended-length can be read here.
09/10/2025
RESPONSES/COMMENTS (HEALTHCARE FRAUD)
RE: New Chicago-Based Health Care Fraud Section
From: Paul Kesselman, DPM
A recent announcement from the OIG detailed a new Chicago Section of Health Care Fraud, which will work with the local US Attorney General and Health Care Strike force to pursue those who engage in healthcare fraud. This new section will not limit itself to the Chicago metro area, but actually investigate and prosecute those within their jurisdiction who cross state lines. While prosecuting those who endanger the welfare of the Medicare Trust Fund, let's be mindful of the honest providers who may get caught up in these types of investigations. Often, eager prosecutors wish to gain their merit badges by investigating and indicting the "ham sandwich". On the other hand, it is refreshing to note that the OIG finally is responding to investigations of:
New suppliers who rev up just too quickly with a large volume of claims for one specific product. Existing suppliers with acceptable number of claims for a specific product which suddenly revs up their claim numbers.
Suppliers who submit a high number of claims for those products on the government radar (e.g., back and knee braces). Whistleblower complaints coming from employees who suspect their employer is engaged in fraud.
The take home message is to continue to provide DME while improving your documentation supporting medical necessity for any DME you prescribe or dispense.
Paul Kesselman, DPM, Oceanside, NY
09/08/2025
RESPONSES/COMMENTS (OBITUARIES)
I am so saddened to hear about the passing of Dr. Robert Eckles. I had the pleasure of working with him at NYCPM for many years. Bob took over my job as Dean of clinical education. He will be remembered for his intelligence, superior understanding of bio mechanics and his caring for patients. My condolences to his family and all the hundreds of students he impacted.
Terry L. Spilken, DPM
09/06/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE MILITARY)
From: Robert K Hall, DPM
I was being drafted in 1968, so I joined the Army. While I had a bachelor's degree, but without ROTC or OCS, I came in as E-1. I received no orders after basic but went to hospital at Ft. Gordon and met with the head of Mental Health. I was assigned there and was able to get a direct commission as a psychologist. I worked 2 years at inpatient psychiatry, but the last year in "crisis intervention in the ER, as prepping for advanced GRE for a PhD in psychology where I met the "officer of the day" James Black, DPM who suggested podiatry .
I took the extrance exam in Morton Wittenburg's office (He was President of Georgia Podiatry Association), and I got accepted to NYCPM, California, and Philadelphia. I chose Philadelphia as I was offered an academic scholarship.
Robert K Hall, DPM, TUSPM 1975, Fort Lauderdale, FL
09/06/2025
RESPONSES/COMMENTS (OBITUARIES) - PART 2
I was fortunate enough to spend time with Terry Lichty in my senior year at ICPM. He was very generous with his time as he tutored me in his office and at the Illinois State Penitentiary at Joliet. With his leadership, I and several of my classmates were able to perform more procedures than most people did in a year of residency. I fondly remember the dinners that we enjoyed after our rotation at the penitentiary. RIP Terry.
Michael DiGiacomo, DPM
|
| |
|
|
|
