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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:
05/29/2026
RESPONSES/COMMENTS (DME)
RE: $15 Billion Dollar DME Fraud
From: Paul Kesselman, DPM
Becker’s ASC Review recently posted that the DOJ has settled a fraud case against 8 physicians involved in DME fraud, to the tune of $1.5B. One of the physicians was an OB-GYN who signed numerous prescriptions for DME items for Medicare beneficiaries who were not her patients. She agreed to pay Medicare back $507,000 to resolve False Claim Act allegations. She and another physician who agreed to pay back about $62,000 were the low folks on the totem pole. There was one individual who was captured after being a fugitive who was sentenced to 150 months in prison for leading and organizing a $61.5M health are fraud scheme. This involved orthotic braces, foot baths, and genetic testing for patients who did not need any of these DMEPOS.
The list goes on and on. I again ask Medicare why DME fraud is so rampant in the Medicare Fee for Service world, yet you don’t hear much of it going on in the private sector or Medicare Part C plans. The reason is simple. There are much...
Editor's note: Dr. Kesselman's extended-length letter appears here.
05/27/2026
RESPONSES/COMMENTS (PODIATRISTS AND AI)
RE: When Will AI Replace Podiatrists?
From: Dieter Fellner, DPM
Out of curiosity (and perhaps mild professional self-preservation), I recently asked ChatGPT how long it thought it would be before AI and robotics replace podiatrists and surgeons. The response was interesting. AI will likely become extraordinarily powerful in diagnostics, pattern recognition, documentation, workflow optimization, and decision support over the next 10–20 years. No great surprise there.
But when it comes to hands-on procedural medicine? The estimate became much longer. AI pointed out something that is often overlooked by Silicon Valley enthusiasts: medicine is not merely information processing. Even the mundane task of trimming toenails is, in reality, an extraordinarily complex physical interaction. What appears to the casual observer as, “clip nail” actually involves continuous subconscious processing of...
Editor's note: Dr. Fellner's extended-length letter appears here.
05/27/2026
RESPONSES/COMMENTS (HEALTHCARE NEWS)
From: Elliot Udell, DPM
For many years, we have employed the use of dermatoscopes in our practice, and yes it can make a life or death difference for patients. Several years ago, a patient came into my office for care of mycotic toe nails. He asked me to look at a black lesion on his belly. I was quick to let him know that it is totally out of scope for me. He replied that he just came from his dermatologist who looked at it with his naked eyes and said it was nothing. After prodding, I looked at the lesion with my dermatoscope and noted that it had asymmetric borders and different colors, and, as some experts would say, "It was an ugly lesion." I sent him back to his dermatologist immediately with my findings. Three months later, the patient returned to my office and gave me a big hug. The dermatologist did a biopsy and it was indeed a melanoma. The dermatologist told him that his podiatrist saved his life.
To buy a dermatoscope, do a search on Amazon and you will find dermatoscopes ranging from low to high prices. To learn the cardinal signs of how to determine if a lesion is a melanoma or a non-malignant nevus, I highly recommend attending lectures on the topic given by Dr. Steve McClain from McClain labs, and/or read some of the literature on the Internet. You can also attend seminars given by Ashvin Margoob, MD, a world authority on dermatoscopy. The Academy of Continuing Podiatric Medical Education often has Dr. Margoob and Dr. McClain lecture, online, on this very topic.
Elliot Udell, DPM, Hicksville, NY
05/26/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS) - PART 1B
From: Vince Marino, DPM
The comment posed by Dr. Kesselman and especially the follow-up by Dr. Ribotsky are spot on. Today’s practitioner should not only read these articles but REALLY UNDERSTAND what is being said and the economics behind it. Medical practice in general is, after all, a business. Without understanding the economics and points discussed by Drs. Kesselman and Ribotsky, today’s young practitioners will have a very difficult time succeeding in the business of podiatric medicine.
Vince Marino, DPM (Retired), Novato, CA
05/26/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS) - PART 1A
From: Paul Kesselman, DPM
I received this post from a non-physician. He apparently has his pulse on the insurance market, which provides more on the story, not from the public but from the private part of the insurance market. I urge everyone to read this.
Would you actually be shocked (as he was) that the insurance companies actually hid some of their profits using some accounting scheme and that their profits are much larger than they reported? Would you be shocked that the private insurance segment does not want Medicare for all and is doing what they can behind the scenes to stall this? None of those are surprises.
Paul Kesselman, DPM, Oceanside, NY
05/22/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS)
RE: Salary Raises for Physicians
From: Paul Kesselman, DPM
Here in the Northeast, the largest commuter railroad strike ended after 3.5 days. Union workers prior to the strike were paid a median wage of over $140K. With overtime, one train engineer is hauling in a salary of more than $350,000. These figures do not include other benefits, including shift differential, health and disability insurance, and vacation pay. With their new contract they are expected to gain an average of increase of approximately 4% compared to a few years ago from when their previous contract expired. The raises will continue for the next several more years.
Similarly, many LIRR non-union executives have salaries well over $300K. The same is true for our utility executives with hundreds exceeding $500,000 and some deferring payments of well over $185,000 until they retire. Note that many of the union laborers have no college degree and...
Editor's note: Dr. Kesselman's extended-length letter appear here.
05/22/2026
RESPONSES/COMMENTS (INTERNATIONAL PODIATRY IN THE NEWS)
From: Gary S Smith, DPM, Keith Gurnick, DPM
When I first opened practice in a small town in 1991, I discovered that a podiatrist had been here for 25 years before they found out he didn't have a license and he left. Apparently, everybody loved him and thought he was great. His secretary took over his business and went door to door practicing podiatry. She would even call me "her colleague". She "practiced" for several years and there wasn't anything I could do because her husband was the local judge.
I really don't see this as much different than what goes on in rural areas today. There is a local "cardiology center" where you can make an appointment to see the "cardiologist "and he is just a PA. There is no doctor, period. No doctor ever comes to or is affiliated with that clinic. There is a dermatologist clinic that is the same way. Only a PA on staff. There is no doctor and no doctor ever comes to that dermatology clinic though they tell you when you make an appointment you will see a dermatologist.
Gary S Smith, DPM, Bradford, PA
It sounds like she should apply for a job at the Good Feet Store.
Keith Gurnick, DPM, Los Angeles, CA
05/21/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Ken Meisler, DPM
I was glad to see this topic because my practice uses bone stimulators quite a bit. We do use bone stimulators for non-unions but predominantly use them for delayed unions. In addition, we also use them for some fresh fractures. Insurance companies have different periods of time when a delayed union fracture will qualify so that the bone stimulator will be paid for. It may depend on the amount of healing that has occurred by that period.
Bone stimulators can also be approved for fresh fractures and will be paid for by the insurance company in some cases. For example, a Jones fracture where the patient is not a surgical candidate, the bone stimulator may be approved to avoid prolonged non-weight-bearing and possible non-union. Another example is a displaced metatarsal neck fracture that is borderline between needing surgery or not. Healing faster can avoid further displacement and significant mal union. They can also be used for surgery patients if there are concerns about possible delayed fusion.
Finally, I have found patients who develop a fracture this time of year and are very upset they might have to avoid golf or tennis for 2-3 months will consider paying out-of-pocket for a bone stimulator to speed healing. Many of those patients are willing to pay for the bone stimulator themselves to be able to get back to sports a few weeks earlier. Most importantly, I find them very effective.
Ken Meisler, DPM, NY, NY
05/21/2026
RESPONSES/COMMENTS (INTERNATIONAL PODIATRISTS IN THE NEWS)
From: Richard H. Mann, DPM
I would like to extend my heartfelt congratulations to Jeffrey A. Ross, DPM, MD, on his induction as a Fellow of the Royal College of Physicians and Surgeons of Glasgow (FRCPSG). This internationally recognized honor is a reflection of Dr. Ross's decades of outstanding clinical excellence, leadership, and dedication to advancing our profession. We should all be proud to call him a colleague and celebrate this well-deserved distinction.
Richard H. Mann, DPM, Boca Raton, FL
05/20/2026
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Lawrence Rubin, DPM
It is truly unfortunate that so many podiatrists remain unaware of the significant benefits of time-based billing, a missed opportunity that hinders both professional recognition and patient outcomes. By failing to leverage these codes, specialists overlook a vital mechanism for documenting the exhaustive coordination required to collaborate with primary physicians and the intensive counseling necessary for managing chronic conditions like diabetic peripheral neuropathy (DPN) and peripheral rrtery disease (PAD). This gap in knowledge not only undervalues the podiatrist’s complex role in the multidisciplinary care team but also limits the dedicated time spent educating patients on limb-salvage and long-term health.
Lawrence Rubin, DPM, Las Vegas, NV
05/20/2026
RESPONSES/COMMENTS (AI)
RE: More AI Uses and Features
From: George Jacobson, DPM
I don't think the profession is using these new AI technologies in their everyday practice. I have been using AI to evaluate all of my personal market holdings and strategies. I can now monitor CEFs and ETFs for destructive NAV patterns with updated tax estimates. It tracks the amount of room for ROTH conversions without pushing into a higher tax bracket while also tracking the ceiling to receive the maximum additional >65-year old's additional tax deductions.
George Jacobson, DPM, Hollywood, FL
05/18/2026
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW- PART 1B
From: Paul Kesselman, DPM
Having previously spent a few decades applying CTP to many patients, it is a shame what has transpired over the past six years since I retired from practice. We have no doubt killed a golden goose. But gold is not referred to in a monetary fashion for the graft reimbursement, per se, but for what it was worth to the millions of patients whose limbs and wounds were salvaged. The UT case is only one, https://podiatrym.com/go.cfm?n=16088
There is so much blame to go around for this massive problem. Let’s start with the HCPCS common work group, which...
Editor's note: Dr. Kesselman's extended-length letter appears here
05/18/2026
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW) - PART 1B
From: Brian Kashan, DPM
Once again, podiatrists/physicians are being used as the pawn in the chess game of medical supply and pharmaceutical companies. This is nothing new, but the stakes are getting higher with the increased costs of drugs and products. What is not new, are these companies refusing to take on any risk, and make the lion's share of profit. Without us, they have no business, but they refuse to partner with us when it comes to risk.
Years ago, when skin substitutes became available, I asked the rep (from a well known and large company) to share the cost risk with me. The product was a thousand dollars or so, and the application of it paid about...
Editor's note: Dr. Kashan's extended-length letter appears here.
05/18/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Bret M. Ribotsky, DPM
Dr. Hultman’s recent contribution to Podiatry Management on physician financial literacy is a commendable starting point, yet it necessarily sacrifices depth for accessibility. For the physician genuinely committed to understanding the financial architecture of a private practice — rather than merely its surface appearance — a more rigorous framework is warranted.
My perspective is informed by direct involvement in the mergers and acquisitions space, having evaluated and facilitated the consolidation of multiple dermatology practices into private equity platforms. In that context, one learns quickly that sophisticated acquirers are largely indifferent to top-line revenue or a conventional profit-and-loss statement in isolation. Their analytical focus falls on normalized earnings,...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
05/15/2026
RESPONSES/COMMENTS (PODIATRIST AND THE LAW)
From: Farshid Nejad, DPM
The graft companies should also be charged as an accomplice to these crimes. Most who have used these grafts know that there is an IVR system to check billing codes, insurance, etc. to ensure the claim will be eligible for payment. Red flags in this process should prevent sale to the physician. Some might argue that this idea is wrong, but these few cases of fraud vs the legitimate sales that the graft companies are doing is easily comparable on their side. But the graft companies choose profit over ethics, without risk.
Farshid Nejad, DPM, Beverly Hills, CA
05/14/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Jon Purdy, DPM
Podiatry is unique in some ways and mainstream in others. When my father was in practice, it was a time when podiatry schools were accepting students not academically able to get into medical school. Reimbursements at the time were significantly higher and insurance was not a limiting factor. It was an easier path to a high return on investment.
Fast forward to our somewhat better acceptance into mainstream medicine, advancement in our education and training, as well as scope of practice. This has led to an increase in time, educational costs, and a higher bar for acceptance to podiatry schools. The medical practice environment has slashed the return on investment for everyone. We have inadvertently leveled the playing field while maintaining a narrow scope of practice. This without a doubt has made one’s decision to go into podiatry less appealing.
Orthopedics began as a pediatric deformity specialty. Modern ortho for the most part abandoned the babies, and most ortho practitioners limit their practices to certain joints and body parts. Podiatry is no different. We have evolved, and let’s face it, have painted ourselves into a corner of modern medicine. We are being outpaced by nurses of all things. We have serious decisions to make about our profession and its leadership. Letting titles, history, and ego stand in the way will be of no help.
Jon Purdy, DPM, New Iberia, LA
05/14/2026
RESPONSES/COMMENTS (EDI)
RE: HETS Electronic Data Interchange (EDI) Enrollment
From: Michael Loshigian, DPM
All providers and suppliers must enroll in HETS Electronic Data Interchange (EDI) to check Medicare beneficiary eligibility. Healthcare providers (including suppliers), vendors, and clearinghouses work together for HETS enrollment. CMS will move to a new HETS trading partner management system on May 11, 2026. Complete the enrollment process to ensure continued access to HETS.
Michael Loshigian, DPM, NY, NY
05/14/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Steven Finer, DPM
I really appreciated Dr. Tomczak's extensive article on the history of thought and teaching. In the 1970s, the curriculum started to change at PCPM. MDs were brought in to teach courses such as Internal medicine, orthopedics, neurology, radiology and many more. PhDs taught pharmacology, microbiology, and histology. For the most part, podiatrists taught podiatric subjects. The chiropractic schools are often criticized as to their own teaching of all subjects.
Steven Finer, DPM, Philadelphia, PA
05/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Podiatric Paradigms, Incommensurability, and Transformative Learning
From: Rod Tomczak, DPM, MD, EdD
In 1962, Thomas Kuhn, a professor at numerous highly acclaimed universities such as Princeton, Harvard, Berkley, and MIT published his seminal work, The Structure of Scientific Revolutions. It was extremely influential across multiple disciplines, but for us it was powerful in change theory for education and science. Kuhn introduced the concept of paradigm and paradigm shift in order to explain how we think about the structure of ideas and how those ideas change.
We know that over time, paradigms shift and we have a change in how we think about things. Over time, we evolved from a geocentric to a heliocentric universe. When the idea of change was originally set forth, it was not readily accepted and heliocentricity was the reason Copernicus was excommunicated by the infallible Catholic Church. The Church preached a geocentric universe. Such diametrically opposed ideas were incommensurable, meaning they were not able to be discussed because...
Editor's note. Dr. Tomczak's extended-length letter appears here.
05/13/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Patrick A. DeHeer, DPM
As part of APMA’s comprehensive compensation survey, conducted in partnership with Marit Health last fall, we asked the more than 1,300 respondents to share information about call compensation. Members can access the data at www.apma.org/compensationreport. According to our findings, about 55 percent of podiatrists take call, but only about 12 percent of those taking call get paid. The median call rate was $350/night.
APMA also offers members an on-call resources page at www.apma.org/oncall. Members will find information on negotiations, APMA’s position statement on call reimbursement, and more. I urge members to take advantage of these important resources to help gain appropriate compensation for your time spent on call!
Patrick A. DeHeer, DPM, IN, President, APMA
05/13/2026
RESPONSES/COMMENTS (LICENSING ISSUES) -PART 1B
From: Evan F. Meltzer, DPM
I have been following the discussion in this newsletter about podiatrists obtaining a plenary license. I would like to invite our colleagues who have the “DPM, MD” credentials after their names to describe how they earned their MD degree. Perhaps there is a viable pathway that could be used as a possible model to achieve this goal.
Evan F. Meltzer, DPM, retired, Rio Rancho, NM
05/13/2026
RESPONSES/COMMENTS (LICENSING ISSUES) - PART 1A
From: Allen M. Jacobs, DPM
Dr. Kornfield, in my opinion, is correct in his conclusion that much of what constitutes the daily practice of podiatry involves treatment decisions which have systemic implications, such as the prescription of anti-inflammatories, antibiotics, or analgesics. The legal ability to prescribe such medications is an acknowledgement of the capability and competence of the DPM degree. The DPM degree is a privilege which carries major responsibility. The DPM degree is also trusted to provide self-regulation. The DPM degree is a trust by the state in which he or she practices that the individual acquiring that degree is a qualified individual by virtue of education. Four years of podiatric medical school and three years of residency. For some, an additional fellowship year.
The DPM degree is a powerful medical degree. With the DPM degree, you will determine the need for treatment, including the use of medications which can result in harm or adverse sequelae. The DPM degree awards you the ability to determine the need for surgery, the candidacy of that patient for surgery, and the nature and extent of that surgery. The DPM degree allows you to...
Editor's note: Dr. Jacobs' extended-length letter appears here.
05/12/2026
RESPONSES/COMMENTS (PODIATRIC RESIDENTS)
RE: Quality of Podiatric Residents
From: H. David Gottlieb, DPM
I recently completing a site visit of a podiatric residency program that is sponsored by a Level 1 trauma and teaching hospital. They have over 700 residents in total, encompassing all medical and surgical disciplines including podiatric medicine and surgery. I found this to have been an exciting evaluation.
The MD attendings from every specialty commented on how eager, capable, and knowledgeable the podiatric residents are. In fact, they all said that the podiatry residents were equal to, and better in some respects, than the MD residents. The most frequent comment voiced was that they wished the podiatry residents were on their service all the time. I do not find this to have been eye-opening as I already know the talent that our residents have, even if some of the readers of this newsletter refuse to believe it.
H. David Gottlieb, DPM, Columbia, MD
05/12/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Kudos to Bryan Groleau
From: David S. Wolf, DPM
Kudos to Bryan Groleau, Director of Clinical Education at Medi USA. I have recently had a patient at our Homeless Clinic with severe secondary bilateral lymphedema (from chemotherapy) who was in dire need of compression dressings.
Bryan was kind enough to donate numerous samples of their Circaid inelastic adjustable compression wraps, not just for her, but for our other patients who are at the mercy of the street. These are the kind of acts of generosity that make a real difference to our underserved and uninsured population.
David S. Wolf, DPM, Retired, Houston, TX
05/12/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Kenneth Meisler, DPM
One of the doctors who responded to this mentioned that curettes are one of the instruments frequently stolen. I have found that thin lightweight instruments like a curette, scalpel handle, or a very small nail splitter can frequently be left in the debris tray and thrown out by mistake. In 51 years of practice, I don't think we've caught anyone stealing instruments, although I'm sure it has happened. I think many more have been accidentally thrown out.
Kenneth Meisler, DPM, NY, NY
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