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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:
05/13/2026
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 (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.
05/13/2026
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 (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
05/12/2026
RESPONSES/COMMENTS (LICENSING ISSUES)
From: Robert Kornfeld, DPM
Dr. Samuel Makanjuola brings up a decades old issue. It’s not just the 10 years he has been in practice. It’s the almost 46 years since I graduated NYCPM. But here is what is interesting about podiatry. When we prescribe NSAIDs, are we treating the foot? No, we are not. We are treating the immune system. Same when we prescribe steroids. When we prescribe narcotic analgesics, are we treating the foot? No we are not. We are treating the CNS. I can cite many more examples. Of course, we can only do these things in relation to podiatric pathology, but we are absolutely allowed, on a legal level, to treat systemically in order to address the pathology we are licensed to treat.
We’ve been halfway there for decades. Yet, the people we have appointed for all of these years as the spokespersons of this profession seem to have only been able to keep us stuck. So I took a different track. If I’m licensed to suppress the CNS, the immune system, alter the microbiome with antibiotics, and...
Editor's note: Dr. Kornfeld's extended-length letter appears here.
05/12/2026
RESPONSES/COMMENTS ( CODING & BILLING Q&As FROM CODINGHELPLINE.COM)
From: Lawrence Kosova, DPM
Dr. Freedman, this is an excellent response on many levels. In the medical AI community, this is all discussed and dissected. I was at a Becker's Healthcare meeting last year in Chicago with just about every hospital and administrator in the US. I listened to a panel for Cleveland Clinic and a few other hospitals and they went over their implementation of AI, starting with AI scribe to coding etc. If done correctly, the results are impressive and the adaptation from the doctors are impressive. The system I am involved with has Beth Israel's entire hospital system with close to 5,000 physicians, but a pilot study has to be implemented to address the extensive list you wrote about. This doesn't happen overnight with many pitfalls in between, but honestly, those are becoming much less with experience. But this is at a hospital level.
When lecturing, I address the physician private clinic situation where everything still applies, but addressing workflow and efficiency is key. Not all AI scribes and systems are the same. The built-in AI, regardless of company implemented, seems to be poor. Then the doctor thinks all systems are the same. They are not. I was just at my GI at a major hospital in Chicago and the system is so poor very few are using it. That's a shame. Yes, each doctor has to review their own notes regardless of technology implemented. Also, doctors should not be using "open" AI systems like many of the knowns Chats. This can leave them exposed to legal issues. Closed systems tend to protect against that. I also hope the patients are signing written consents and not verbal ones before use in the office setting.
Lawrence Kosova, DPM, Chicago, IL
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 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
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
05/11/2026
RESPONSES/COMMENTS (AI)
RE: Free OpenEvidence AI for Physicians
OpenEvidence is a free AI for physicians. You have to have an NPI# to join. It even cites references with its answers.
George Jacobson, DPM, Hollywood, FL
05/11/2026
RESPONSES/COMMENTS (APMA NEWS)
From: Robert Scott Steinberg, DPM
Corporations are going to guide our profession, but how exactly? For the Corporate Council Members to be of value, the APMA BOD needs to provide it with a roadmap. The profession knows what we need. Corporations can provide valuable guidance in creating a more efficient and financially sound structure, and greatly improve our PR with the public about our profession.
Robert Scott Steinberg, DPM, Schaumburg, IL
05/11/2026
RESPONSES/COMMENTS (LICENSING ISSUES)
RE: The Case for a Plenary License
From: Samuel Makanjuola, DPM, MEd
I know this was brought up before, but I think we as a profession have to address it. Scope of practice is all over the place for different states; this isn't unheard of even in other MD/DO specialties. That being said, the limited scope really does significantly affect practice. More importantly, it affects patients and the care they receive.
A few examples come to mind. Recently, I had someone come see me for "gout" - this is something I could technically treat; but can I? If I give colchicine for the acute phase, I think most would agree that that's the correct course of treatment. This patient, however, had gout of the wrist, and didn't realize he scheduled with a podiatrist. Now the location doesn't change the pathology and, again, technically I could prescribe...
Editor's note: Dr. Makanjuola's extended-length letter appears here.
05/11/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Keith L. Gurnick, DPM
Each and every practice is different. Some podiatrists have offices in large medical buildings, some work in hospital-owned clinics. Some podiatrists work in free-standing buildings and others have offices in strip malls. Our patients and office staff come from a wide diversity of backgrounds and ethics and morals. Instruments left out on the counter, or even in treatment room drawers can be taken by patients, office staff, nurses, assistants, and the cleaning crew, or on occasion can be also mistakenly be moved from one room to the next.
One way to avoid instrument theft is to have (and use) locking drawers, and also to not leave your instruments where a patient or the cleaning crew can take them when the doctor exits the treatment room. If you open a double wrapped sterile pack, when you are done, close the pack up and...
Editor's note: Dr. Gurnick's extended-length letter appears here.
05/08/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Judd Davis, DPM
Dr. Carnett brings up a great point as well. He states that "cold sterile instruments might be accepted practice," here in the U.S. It should NOT be, as most of those instruments are not sterile. AI search reveals that Australia, the UK, Canada, and most European countries REQUIRE all podiatry instruments to be autoclaved between patient uses. It even states that undeveloped countries are getting away from the chemical disinfection of instruments and moving to autoclaves because chemicals are too unreliable. There appears to be more gray area around this topic in the U.S. as the AI states, it's up to the individual state boards, CDC recommendations...whether or not instruments are autoclaved. Why is that? We are a developed nation.
I looked up the info on one of the most predominant chemicals used in those trays and an instrument has to soak for 10 hours to be sterile. The 5 minutes between patient to patient simply doesn't cut it and potentially allows for transmission of disease from one patient to the next. Hopefully, all podiatry schools have autoclaves now for student use and have gotten away from chemical trays. Remember, do no harm. Every podiatrist should be autoclaving all instruments and you won't have to worry about them being stolen out of the exam room. When it's an established patient that I know, I grab the instruments I need right off the autoclave tray ahead of time. If its a new patient, I excuse myself from the room for a moment to gather the autoclaved instruments I need.
Judd Davis, DPM, Colorado Springs, CO
05/08/2026
RESPONSES/COMMENTS ( CODING & BILLING Q&As FROM CODINGHELPLINE.COM)
From: David J. Freedman, DPM
I just came back from the 2026 AAPC Healthcon Conference where AI was a significant topic of discussion to over 3000 attendees. The purpose of my post was to explain to the masses who use templates created by them or their EMRs was really about the pitfalls and warnings they need to be aware of in charting. So, let's be honest, doctors do not change quickly when it comes to charting opportunities. On the flip side, those who are engaging AI need to understand it and the fact of issues that have been brought up just at this very conference this week.
While on the surface, AI can make each visit "unique" to that patient's visit as you stated Dr. Kosova, what the auditors are seeing is old habits do not die. For example, "Copy & Paste"; to save time, many doctors just bring forward old information even using AI. What most do not understand is that information does not necessarily count toward...
Editor's note: Dr. Freedman's extended-length letter appears here.
05/08/2026
RESPONSES/COMMENTS (CODING & BILLING)
RE: The Benefits from the Proper Use of E/M Codes
From: Joseph Borreggine, DPM
Last evening, I attended a webinar presented by Allen Jacobs DPM. This webinar had a follow-up lecture with Dr. Michael Warshaw a retired podiatrist from Florida, a leading Medicare consultant who evaluates audits conducted on podiatry practices. Dr. Warshaw provided CMS policy and information to support every claim made by Dr. Jacobs, ensuring the accuracy and validity of his information provided.
Dr. Jacobs, as we know, is an esteemed and respected podiatrist with over 50 years of experience in the field, shared insights that have been beneficial to my podiatric practice and E/M...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
Dr. Warshaw joins Podiatry Management as a regular columnist starting with the August 2026 issue.
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Fifty-three years ago when visiting podiatrists before committing to podiatry school, I visited a number of podiatrists who wore a nylon jacket similar to what a dentist or optician wore. Almost everyone of the podiatrists would ask the patient what was wrong and while the patient explained, the podiatrist pulled a large bone cutter out of the jacket pocket and started cutting toenails. The podiatrist would say something similar to, "Let me shorten these nails while we talk." As a third -year student at OCPM, an older lady asked me if I was going "to paint her nails" when I concluded cutting them? Thank God I had a spray bottle of Merthiolate to make the experience an "antiseptic pedicure."
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Ivar Roth, DPM, MPH
I always get a chuckle out of reading Dr. Jacobs’ responses to some of my posts. Here are some of my observations after I completed a comprehensive 3-year residency in foot and ankle surgery some 40 plus years ago.
Having been blessed and trained to have excellent hand eye coordination from performing surgery, I adapted and used these skills to what I consider perfecting the medical pedicure. From my close association to routine care and what I saw daily... athletics foot, fungus nails, and IPKs... I was able to come up with cures and I do not say that lightly for athletics foot, fungus nails, and recently the resolution of IPKs... all of these conditions which have been hopeless to resolve until now. I am currently in discussions with academic centers to have FDA studies done to prove what I have discovered and bring these cures out to the public. I envision podiatrists leading the way so we can claim some glory and re-imagine what podiatry has to offer to the medical community. Again, thanks to Dr. Jacobs for his pithy comments.
Ivar Roth, DPM, MPH, Newport Beach, CA
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1C
From: Allen M. Jacobs, DPM
It seems to me that the majority of contributors to PM News are of the older generation such as Kesselman, Udell, Warshaw, Secord, Ribotsky, Oloff, Tomczak, myself, and many others. In general, these are individuals who have devoted a portion of their lives to efforts at the advancement of this profession through the participation in educational activities. I suspect the majority of PM News readers are of the same generation, as we seldom witness commentary from younger podiatric physicians, as can be seen, for example, on the podiatry student network.
As a direct consequence of decreased college enrollment, we are now witnessing a phenomena which was unimaginable years ago: unfilled residency positions. It is ironic than at a time that our profession has reached the summit of integration and acceptance in medicine, for which our podiatric forefathers such as Earl Kaplan and Dalton McGlamry, ...
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Paul Kesselman, DPM
Prior to entering podiatry school in 1977, I had the habit of walking around in stocking feet while in my parent’s apartment. This never caused an issue there. One day, I was in stocking feet while visiting my girlfriend's (now wife’s) parents and attempted to walk down a set of wooden steps to their basement. Well needless to say, I rapidly surfed my way down to the bottom of the steps. Fortunately, no serious injuries occurred other than to my pride and ego.
A publication from 2012 “Footwear and Falls in the Home Among Older Individuals…” stated what most of us already know: “Available evidence indicates that older people going barefoot, wearing only socks, or wearing slippers may be at considerably increased risk for falls...
Editor's note: Dr. Kesselman's extended-length letter appears here.
05/07/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Jeff Carnett, DPM
Dr. Ross brings up an important point. While cold sterile instruments might be accepted practice, podiatry boards in multiple countries require autoclaved instruments for each case-including routine nail care. This would make it clear that instruments are indeed sterile and individual packs brought into the room would avoid instruments walking away.
Jeff Carnett, DPM, Phoenix, AZ
05/07/2026
RESPONSES/COMMENTS ( CODING & BILLING Q&As FROM CODINGHELPLINE.COM)
From: Lawrence Kosova, DPM
These are all great examples of misuse of templates that most of us have gotten used to over the years. I challenge you is to why you even need a template in the age of AI. Yes, you can have an outline like a SOAP note but AI will fill in the rest, in the right spots, and you don't have to worry about having the exact hard-coded language for the same type of patient repeating. The insurance companies look for patterns. Even if it's routine care, AI can make each visit "unique" to that patient's visit, even if it's for the exact same treatment plan. Most doctors I know that are using AI are no longer using "Smart tabs", etc. They are finding out quickly that they are [not] so smart after all.
Lawrence Kosova, DPM, Naperville, IL
05/06/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Bret Ribotsky, DPM
Dr. Teitelbaum has once again put his finger on a wound that has festered for decades. The “routine foot care” designation is not merely a billing inconvenience — it is an institutional insult that has shaped how our profession sees itself, and perhaps more importantly, how we allow others to define our worth. But I want to add a perspective that the reimbursement debate sometimes obscures: the label matters far less than the performance.
Whether CMS calls it routine or not, whether we are classified as allopathic, specialty, or profession — none of that determines the ceiling of what an individual practitioner can achieve. What does determine it is the quality of care delivered, the skill of communication with the patient, and the ethical clarity with which a fair value is established for...
Editor's note: Dr. Ribotsky's extended-length letter appears here.
05/06/2026
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Elliot Udell,DPM
The problem we see in our practice with patients who walk barefoot at home or on their outdoor decks is the risk of foreign bodies. Every summer, we deal with patients who get glass, wood, and other objects in their feet. The typical scenario is that a patient will give in their history that someone in the family broke a glass in the kitchen or on their outdoor patio, and then quickly add, "but we cleaned it all up." My response when I show them the spicule in the hemostat is, "You obviously missed a piece."
Those patients are not wrong. They did do a cleaning job but shattered pieces of glass can travel and small fragments are not always visible to the naked eye. I respect Dr. Conenello's opinion that barefoot walking may offer some benefits. Those of us who have taken yoga or martial arts classes will recall that the teacher requires the class to be taken without footwear. Because of the risk of foreign bodies, however, I am vehemently against people walking around without shoes and socks in their homes.
Elliot Udell, DPM, Hicksville, NY
05/06/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1A
From: Allen M. Jacobs, DPM
Medical pedicure Dr. Roth? "Medical pedicure" is a euphemism for cutting toenails or calluses. Seven years post-graduate education for a "medical pedicure"? Making toenail and callus trimming more palatable and profitable for you by equivocation does not alter reality. Seven years and greater than $250,000 debt are not justified for the provision of a "medical pedicure". Equivocation may assist you in attributing greater significance to what you do rather than the reality that cutting toenails and calluses is just that, cutting toenails and calluses. The provision of these services may be necessary for some patients, but as they say, "let's call a spade a spade". In the old days, they called it by the German adverb "schneiding". Medical schneide anyone?
Allen M. Jacobs, DPM, St. Louis, MO
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