03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Judd Davis, DPM
Dr. Jacobs states that, "These are indeed the best of times to be a podiatric physician. Utilizing Medicare reported RVUs, the average podiatrist should earn a minimum of $269,900 annually." That may be the case for gross income, but certainly not for net income take home pay. Chat GPT and Gemini AI searches both state that the average net pay is around $150K. This is the bottom of the pay scale as far as medical specialties go. Maybe Dr. Block can post the most recent annual survey results for net and gross pay to help confirm these numbers?
I have personally watched my income being eroded away by ever increasing overhead and stagnant unchanging reimbursement from Medicare and most commercial insurances, even witnessing some podiatrists being pushed right out of business for this reason. In 1987, I had B/L matrixectomies done and my parents paid $800 cash, and thought wow, I can help people and make that kind of money. Sign me up. Today, almost 40 years later Medicare pays...
Editor's note: Dr. Davis' extended-length letter can be read here.
03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: James DiResta, DPM, MPH
I appreciate Dr. Jacobs ‘recent entry and the accolades provided and I couldn't agree more. The profession of podiatry has come of age and podiatrists are in a better and more envious position today than ever. I know as I experienced these last 40 plus years and I can only look back with gratitude on what collectively we have accomplished. But we have a problem. A very big problem and it couldn't be more obvious to anyone who has been involved in graduate medical education and it should be obvious to our profession as a whole. Calling the problem transient is delusional and won't fix it. Marketing wont fix it.
Our student applicant pool is dwindling and the strength of that pool is, well, let's just say it's lacking. If you don't see it go and look at the numbers yourself and when you can't find all the numbers (trust me nobody in authority is releasing them) ask yourself why? Call. Request them in writing. What you'll get is bits and pieces at best and you'll start to see that something is not right. This pattern of acceptances is going to catch up with us. TUSPM, one of our jewels, had matriculant MCAT scores of 500 just ten years ago and that has gone down to...
Editor's note: Dr. DiResta's extended-length letter can be read here.
03/23/2026
RESPONSES/COMMENTS (OBITUARIES) - PART 1C
From: Andrew Schneider, DPM
On behalf of the American Academy of Podiatric Practice Management, I am deeply saddened to hear of the passing of our past President and former Chairman, Dr. Hal Ornstein.
Hal was a larger than life figure who could raise the energy of any room the moment he walked in. He was deeply engaged with and respected by leaders throughout the profession. But Hal’s true calling, where he shined brightest, was in connecting with new practitioners and podiatrists who were struggling in practice. He would take them under his wing and serve as a mentor, asking for nothing in return. That was Hal’s enduring spirit: what can I do?
Hal’s presence in exhibit halls around the country was unforgettable, as if a...
Editor's note: Dr. Schneider's extended-length can be read here.
03/23/2026
RESPONSES/COMMENTS (OBITUARIES) - PART 1B
I am writing with a very heavy heart on the passing of my friend and colleague, Hal Ornstein. Hal’s vision, leadership, and unwavering commitment to others made him an extraordinary person and his impact on so many people, including me, will never be forgotten. He was truly a remarkable man whose kindness and generosity made a lasting difference in my life
As a respected mentor, the advice he gave me was invaluable in helping my practice grow, thrive and prosper. His positivity was infectious and believed that life only gets better with each passing day. As a friend, he was always genuinely concerned for the well-being of my wife, me and my family. He always said his hello’s and goodbye’s with a warm loving hug.
I want to express my deepest condolences to his family and to all those who were fortunate enough to know and work with him. I hope they find comfort in the love Hal shared and in the many memories he created. I will keep his family in my heart during this incredibly difficult time. May his memory be forever a blessing as I know it will be. Rest in peace, Hal, I will miss you deeply.
Marc Haspel, DPM
03/23/2026
RESPONSES/COMMENTS (OBITUARIES) - PART 1A
From: Robert Frimmel, DPM, Elliot Udell, DPM
Hal was a classmate, colleague and friend. I always appreciated his help with setting up practice management lectures at SAM. Hal was instrumental in referring Dr. Craig Conti, to our practice, ultimately becoming a partner at Sarasota Foot Care Center. He was a true gentleman and will be missed. Rest in peace.
Robert Frimmel, DPM, Sarasota, FL
It has been said that a person is remembered not by what they take from this world but by what they give back to their fellow humans. Hal Ornstein was the epitome of this. He lectured at seminars all over the United States but did not bask in his glory. He did not have a shred of arrogance. He was a people person. I vividly remember attending a presentation he gave at a SAM conference in Orlando. He burst into a lecture hall, direct from the airport. Everyone clapped. He had a pile of books under his left arm, covering different topics relating to human behavior. He gave them as gifts to attendees. He lectured for half an hour or so, then ran out to catch the next plane to another city to make another group of people happy. I once wrote to his society with a practice management problem. I was shocked when he and another respected colleague called me and spent an hour figuring out a solution to my problem.
Podiatry and humanity lost a kind soul. Hal was a good man.
Elliot Udell, DPM, Hicksville, NY
03/20/2026
RESPONSES/COMMENTS (OBITUARIES)
From: Bret M. Ribotsky, DPM
The world of podiatric medicine lost one of its brightest lights with the passing of Dr. Hal Ornstein — a Hall of Fame practitioner, a master of practice management, and a man whose infectious spirit transformed every room he entered. To those who knew him, Hal was more than a colleague. He was the living embodiment of what it means to practice medicine with joy, purpose, and an unrelenting commitment to lifting others along the way.
Within our profession, Hal occupied a singular place — our own Patch Adams. Much like the legendary figure immortalized by Robin Williams on screen, Hal understood something that many practitioners spend entire careers searching for: that humor, humanity, and healing are not separate pursuits but deeply intertwined ones. He walked into every lecture hall, every consulting room, and every professional gathering with that same...
Editor's note: Dr. Ribotsky's extended-length tribute can be read here.
03/20/2026
RESPONSES/COMMENTS (MEDICARE ADVANTAGE)
RE: Yet Another MCR Advantage Plan Is Penalized for Inappropriate Data Mining
From: Paul Kesselman, DPM
In a recent Becker's Health Care posting, Aetna was cited with a $130M "slap on the wrist" for False Claims Actions. Apparently they too have joined the club of many other "elite" MCR Part C (I refuse to use the "A" word) carriers who are bilking our Medicare Trust Funds of billions of dollars.
How, you ask? Same old story, with their data mining schemes where many of our colleagues gladly provide the data either for free or take inconsequential money for the data?
How about refusing to provide the data at all? Most of these Medicare Part C contracts only require providers to provide data on claims they submit; not on diagnostic data used to inflate Medicare Part C Risk Adjustment data.
Paul Kesselman, DPM, Oceanside, NY
03/20/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Allen M. Jacobs, DPM
Podiatric physicians serve as hospital chairpersons of the medical staff. Podiatric physicians as chairperson of the hospital department of surgery. Podiatric physicians as chairperson or members of hospital committees.
If memory is correct, I park in the same doctors parking lot as the MD/DO. I perform surgery in the same operating room suites. I write orders for the treatment of my patients which orders are carried out by any and all hospital personnel. I sit and eat and exchange conversation in the same doctors lounge. MD and DO physicians ask my advice and direction for the management of foot and ankle pathology. I am treated as an equal and my DPM degree is respected for its representative accomplishment to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/19/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Paul Kesselman, DPM
I too am an alumnus of the Illinois College of Podiatric Medicine, Class of 1981. For my colleagues reading this, they too will remember being taught biomechanics, both theory and practical, from sophomore to and through senior year and even in post-graduate residencies and preceptorships.
As part of our clinical rotations, we were mandated to cast a patient, take it up to the lab, pour the positive, mold/vacuum press the orthotic, add the top cover, and complete the entire assembly process. Of course, this was after performing a complete lower extremity biomechanical examination from the hip distal to the toes.
While orthotic fabrication during my clinical practice years was left to the laboratory, adjustments were mostly performed in-house by...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
03/19/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Joseph Borreggine, DPM
Two esteemed podiatrists, Drs. Amarantos and Jacobs have dedicated their careers to advancing the field of podiatry. Both recently have addressed crucial topics that are essential to our profession. Dr. Amarantos has expressed his concerns about how the podiatric profession has historically overlooked a vital aspect of our practice, biomechanics, and relegating it to a secondary position.
As a graduate of Scholl College in 1988, after transferring from CCPM during my freshman year, I was fortunate to have access to Scholl’s renowned in-house orthotic laboratory and the expertise of Professor Oleg Petrov DPM, a former CCPM graduate who joined the faculty in 1979. This collaboration between podiatric expertise in sports medicine and biomechanics became an integral part of the...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
03/18/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: The Best of Times, The Worst of Times
From: Allen M. Jacobs, DPM
Duality and contradiction summarize the opinions expressed in PM News with regard to the future of podiatry. Like the opening sentence of Dickens A Tale of Two Cities, “it was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”
These are indeed the best of times to be a podiatric physician. Utilizing Medicare reported RVUs, the average podiatrist should earn a minimum of $269,900 annually. An eclectic array of the full integration of podiatry exists. Podiatrists as members of the IWGDF. Podiatrists as committee chairpersons in the ADA. Podiatrists as contributors to IDSA guidelines and holding fellowship status. Podiatrists designing and receiving...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/18/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Gregory T. Amarantos, DPM
Dr. Caringi asks a simple question with a multitude of answers and/or reasons. I too graduated in the early 1980s (1982) from Scholl College and had excellent instructors teaching me biomechanics. What happened?
3-year residencies focused on surgery. There is a certain panache when called a “surgeon” and we all have egos. Schools changed their marketing strategies focusing on surgery. Follow the money, as always. In the ‘80s and into the ‘90s, surgery was fairly well reimbursed. Colleagues became lazy and had/have the medical assistant cast/scan and use Biofoam (what a joke) to build orthotics. Orthotics are not covered by insurance
The surgical portion of my practice was never more than 15% of my revenue. I loved the biomechanical aspect of my practice and it provided me with an above average...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
03/18/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Joel Lang , DPM, Alan Sherman, DPM
The patient can specify on her consent form that the procedure only be performed by her specified doctor and no one else.
Joel Lang, DPM (retired), Cheverly, MD
I would tell the patient who is concerned who will actually do her colonoscopy procedure to look the doctor directly in their eyes and ask him or her. I doubt that many would lie. Based on their answer, she can decide whether to proceed with the procedure or not.
Alan Sherman, DPM, Boca Raton, FL
03/17/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Greg Caringi, DPM
I recently had to go for physical therapy for a neck problem - an occupational hazard. The physical therapist I saw is hands-down the best in my community. He thinks outside-the-box. I always referred my most difficult cases to him when I was still in practice. He asked me - what is the story with The Good Feet stores in our area? He is 60-years-old, and his perception is that podiatrists are the masters of foot biomechanics and custom orthotics. It certainly was true when I graduated in 1980. I explained to him that the profession of podiatry has, over the years, given away our claim to being experts in this area and allowed the rise of retail shops like The Good Feet Store to take away that part of our practice and that part of our income.
Graduating in 1980, I understand the strong mission of our profession to become the recognized foot and ankle surgeons of choice. My residency was at Kern Hospital. It was still, however, evident to me that the success of our profession was the ability to solve our patients' problems with techniques that did not always involve surgery. That is what separated us from the orthopedic surgeons. We gave away what made us special. When I first went into practice, I taught part-time in the Department of Orthopedics at TUSPM (PCPM) in the gait lab and teaching the second-year students how to perform a proper biomechanical exam, gait analysis, orthotic casting and the actual fabrication of the devices. What happened?
Greg Caringi, DPM, North Wales, PA
03/17/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Ed Davis, DPM
Drs. Hwrynak and Graziano discuss the decrease in third-party fees paid to podiatrists. It is important to consider that we engage in contracts of adhesion when contracting with big insurance companies that leave little room for negotiations and even less room for negotiations.
“An adhesion contract exists if the parties are of such disproportionate bargaining power that the party of weaker bargaining strength could not have negotiated for variations in the terms of the adhesion contract. Adhesion contracts are generally in the form of a standardized contract form that is entirely prepared and offered by the party of superior bargaining strength to consumers of goods and services. Adhesion contracts are commonly used for matters involving insurance, leases, deeds, mortgages, automobile purchases, and...
Editor's note: Dr. Davis' extended-length letter can be read here.
03/17/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Are Large Groups Calling Your Office and 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. Hrwynak's extended-length letter can be read here.
03/17/2026
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Is Podiatry Aboard the Pequod?
From: Allen M. Jacobs, DPM
Mark Twain famously proclaimed, “the reports of my death have been greatly exaggerated.” Do we maintain a profession whose anticipated demise has been greatly exaggerated? Reading PM News, one feels like Queegueg in Moby Dick, who rolls the bones and says “build me a coffin.” Is podiatry aboard the Pequod? The Titanic? The Edmund Fitzgerald?
PM News recently noted the death of Terry Gamache. He was a quiet dedicated podiatrist. He cared for his patients and made them comfortable. He hurt no one. He helped many. He did little or no surgery, and made a modest living. He was a generation of podiatrists past. He was a respected and trusted member of the healthcare community. I emphasize the words respected and trusted.
Podiatry graduates today are...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/17/2026
RESPONSES/COMMENTS (CLINICAL)
From: David Secord, DPM
I’ve been using the Panacos graft and the bleomycin treatments ever since I first started practicing. I list these two together because they attempt to accomplish the exact same thing with somewhat different techniques.
Bleomycin technique: The bleomycin treatment is my primary treatment for verrucae vulgaris lesions and I currently have a 99.7% success rate over 28 years and hundreds of cases with the added benefit that if the person has multiple verrucae, treating just the one lesion will allow resolution of all of them in the course of 5-6 weeks. The procedure entails using the body’s own immune system to kill the wart and follows the path of driving some of the warty material into the dermis, where the body will identify it and raise killer T-cells to the HPV. As these circulate throughout the body, any place with a wart will be affected and the lesions will shrink and...
Editor's note: Dr. Secord's extended-length letter can be read here.
03/16/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: James DiResta, DPM, MPH
I hope that for those readers who were fortunate enough to read Dr. Tomczak's entry on "What we should think about” that you will come to realize what is happening in medical and surgical training in the U.S. and what the future may look like going forward. There is a tremendous outlook for future PAs and NPs. Their educational programs are expanding and they are training more independent and confident providers. They have established residency/fellowship programs at many institutions that podiatry could only dream of practicing in not that long ago. They have programs in many medical and surgical specialties and subspecialties including orthopedics, and they have training programs and educational events with the likes of AAOS. They have bills in state legislatures to expand their scope, more independent practice, and independent billing.
I wish I had some level of confidence that the future of podiatry looked as promising but honestly with our heads in the sand, and our inability to envision increased scope and practice for podiatry going forward thkat option is not...
Editor's note: Dr. DiResta's extended-length letter can be read here.
03/16/2026
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: David Secord, DPM
The most gratifying experience I’ve ever had in this realm was a guy in a suit who came in, presented his info, and the clock started ticking. At some point, there was a loud discussion at the front and I went there to see what was occurring. This gentleman had been there, waiting for 4 hours and not placed into an exam room as no one at my office could get anything but a busy signal at his insurance carrier. He was told exactly what is on the sign in the office lobby: you are responsible for knowing the details of your policy, including how much of your deductible you’ve met and the particulars of your coverage. We will try to confirm your benefits, but the responsibility is ultimately yours.
We offered—again—to see the man out-of-pocket, print a claim for him and let him seek reimbursement from his insurance company—which is the route he eventually chose. Some months later, he....
Editor's note: Dr. Secord's extended-length letter can be read here
03/16/2026
RESPONSES/COMMENTS (FUNCTIONAL MEDICINE)
RE: The Timely Death of the RCT in Health and Healing
From: Robert Kornfeld, DPM
"For decades in functional medicine, we have had to defend the meta-analysis as the gold standard for protocol evaluation, as opposed to RCTs that cannot be performed in a functional medicine approach since it is not the one, but the many arms of the protocol that drives salutogenesis, along with the unique characteristics of the patient being treated." This quote, taken from a very well-written article, says it all. “An analogy of the approach mainstream medical science has operated with could be like someone trying to understand how the rainforest works by studying one leaf at a time in a petri dish in a lab under fluorescent lights, for 12 weeks - then publishing a field guide for every ecosystem on Earth. Randomized controlled trials isolate a single variable, measure a handful of endpoints over months, and declare a verdict for billions of people.” Enej Kuscer - Co-Founder & CEO at NU, Co-Founder and Director at ACIES BIO
We have truly been missing the forest for the trees. So much about the human body needs to be revealed on a patient-specific basis owing to...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
03/16/2026
RESPONSES/COMMENTS (IN THE COURTS)
From: Luke Cicchinelli, DPM
Sincerest and heartfelt congratulations to you Dr. Walter Strash and other respondents for your civil disobedience and for channeling big thinkers of the ages. Your collective actions help shine the way for our young professionals and future leaders. Enhorabuena [congratulations]!
“Let your life be a counter-friction to stop the machine.”-Henry David Thoreau
“Power tends to corrupt and absolute power corrupts absolutely.” - Lord Acton
“If you don’t stand for something, you will fall for anything.” - Malcolm X and others
“The best way out is always through.” Robert Frost
and the frequent sobering reality - "Clowns to the left of me, jokers to the right. Here I am, stuck in the middle with you. Gerry Rafferty and Joe Egan (Stealers Wheel) --- because "injustice anywhere is a threat to justice everywhere." MLK Jr.
Luke Cicchinelli, DPM, Philadelphia, PA
03/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: What We Should Think About
From: Rod Tomczak, DPM, MD, EdD
Don’t think for a moment the healthcare community hasn’t noticed the downtrend in the numbers of podiatry students in this country. This down trend has caused an upswing in other lower extremity care givers. Nurses now treat what chiropodists treated in the 1950s in the United States. Nurse practitioners and physician assistants have expanded their practices, especially considering the fact that these disciplines did not exist until the early 1960s when they originated and it was not until the late 1970s that they became universally licensed. Podiatry has a history of looking to the horizon while these other care givers looked beyond the horizon after we get our heads out of the sand.
Don’t think for a moment the government isn’t aware that for the first time in years, podiatric residencies have gone unfilled because there aren’t enough graduates to fill them. Actuaries predicted what podiatry would need in the future to assure adequate foot care to an increased diabetic population. They also forecast what it would really cost to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
03/13/2026
RESPONSES/COMMENTS (PRACTICE MANGEMENT TIP OF THE DAY)
From: Jon Purdy, DPM
I have a different take on this strategy, and it has to do with the microeconomics of running a practice. One needs to calculate the cost of investing staff time in the recommended “…contact the patient’s insurer to verify active policy, physician network status, procedure coverage, and prior authorization requirements before the appointment…” Supposed the patient does not show up?
We need to remember it is the patient’s responsibility to know everything stated above. What we do is out of convenience for the patient and our bottom line, but not obligation. Most EMRs will give a snapshot of current activity and benefits coverage which we check prior to the visit. Once the patient is established, we have them sign a statement on every visit that what they gave us is active and the coverages are as stated. It now becomes the patient's known responsibility to pay the bill if something has changed they did not make us aware of it. In the case of prior authorizations, many can be done in a couple of minutes while the patient is in the office. For those cases that take time, we check and get prior authorizations done later for the next visit.
True costs of employees are more than most are aware of. One quick example is asking a physician what it costs for a twenty dollar an hour employee to work for an hour. Their response is usually, twenty dollars. One quickly forgets to add payroll fees and taxes, benefits, Workers’ Comp, and liability insurance, to name a few. The cost is usually about thirty percent more. Microeconomics is a fascinating topic and can change the way one practices.
Jon Purdy, DPM, New Iberia, LA
03/12/2026
RESPONSES/COMMENTS (PRACTICE MANGEMENT TIP OF THE DAY)
From: Jon Purdy, DPM
1. Verify insurance before every visit
It sounds basic, but skipping eligibility verification remains one of the costliest mistakes a front desk can make. When a practice fails to confirm active coverage, network status, and patient responsibility ahead of time, the result is predictable: denied claims and revenue that vanishes into the re-work queue.
The American Medical Association recommends that administrative staff contact the patient’s insurer to verify active policy, physician network status, procedure coverage, and prior authorization requirements before the appointment. Building this step into your scheduling workflow, not just your check-in workflow, gives your team time to resolve issues before the patient arrives.
Jon Purdy, DPM, New Iberia, LA
