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11/27/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: Ivar E. Roth, DPM, MPH
I read Ms. McCormick's explanation of why we should have a nail extender work in our office. I would say be careful. I have been a proponent of extenders and have coined the term podiacurist which is a mani/pedicurist doing routine care in a podiatrist's office. The major problem with this has been that once these individuals have been trained by you, they get emboldened and then will leave you and start a routine foot care practice down the street. They will be in direct competition with you and usually take some of your patient load with them.
If Ms. McCormick, who I believe owns a training program for these individuals, had the ability to mandate that they must work under a podiatrist or lose their certification, that would go a long way. In reality, a program through a podiatry school could make this a real legitimate profession and would ensure that the certificate had value and protected the podiatrists.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
Other messages in this thread:
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
05/07/2026
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 (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) - 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 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
05/06/2026
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 (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
05/05/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1B
From: Paul Kesselman, DPM
This article was written almost three years ago and published in Nov/Dec 2023, but based on the feedback just revived, it must have been recently re-posted. I searched both my manuscript and the edited published copy and don't see where I specifically defined podiatry under allopathic. Having said that, Dr. Teitelbaum, brings up an interesting question. Is podiatry allopathic or something else? I am not sure this article ever took a position on this.
Searching the web for a uniform definition of allopathic medicine, I used an AI tool which from the Univ. of Kansas describes allopathy as follows: Allopathic medicine, or "conventional medicine," is a modern, evidence-based system where healthcare professionals (doctors/MDs) treat diseases and symptoms using drugs, surgery, and radiation. It focuses on...
Editor's note: Dr. Kesselman's extended-length letter appears here.
05/05/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1A
From: David Secord, DPM
I thought that the comment upon the use of the term allopathic here was entertaining. I have commented in this listserv about 10 times about the meaning of the term allopathy and had a submission to Podiatry Today published some years back on the topic. This is an excerpt:
As long as I’m on a roll here, I thought I’d also comment on people in our profession referring to MD and DO medicine as allopathic and osteopathic and then putting ‘podiatric medicine’ in a separate category, as if podiatric medicine wasn’t allopathic medicine. There are a certain finite number of medical theories out there, including allopathic, osteopathic, homeopathic, chiropractic, native American Indian pan-theistic naturopathy, witch doctors, Eastern Indian Ayurvedic medicine and...
Editor's note: Dr. Secord's extended-length letter appears here.
05/04/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1B
From: Ivar Roth, DPM, MPH
Dr. Teitelbaum makes many good points that make sense. As medicine's stepchild, we are treated as second class citizens in terms of the medical bureaucracy. But cutting corns calluses and nails is something that could be accomplished by the individual or nail technicians in salons in certain states. If the door to insurance was opened up, everybody would want that “FREE” insurance covered treatment. This is why I think the current process really does make sense and allows the individuals to make that choice if they are willing to pay for our services.
At my office, we offer medical pedicures and we are really busy doing a great service to the community and making a nice living at the same time. I encourage all podiatrists to rethink routine care as medical pedicures and I think you will be very happy with the results.
Ivar E. Roth, DPM, MPH, Newport Beach, FL
05/04/2026
RESPONSES/COMMENTS (PM ARTICLES) -PART 1A
From: Jeff Pinsky, DPM
In response to Dr. Teitelbaum’s response to Dr. Kesselman’s look back and musings on routine foot care’s non-coverage by Medicare as a contributing factor to podiatry’s perceived lesser status among medical professions, I felt I had to jump in. I started practice 40+ years ago as well. I did lots of “routine foot” care while in practice. Most was under the non-covered guidelines from Medicare. Even though a minority had class findings, I could fill a stadium with those who did. Notes were well documented (back in the days before A.I. note generation and scribes) with the why and what of each visit, and I never had an issue with Medicare denials or inquiries. I was never looked down on by my MD and DO peers. Yep, we considered each other as equals, as were the local dentists; audiologists, not so much. I think it’s the retail aspect that put them “one rung down the professional ladder”.
And about dentistry: at least in my practice region, there were more unmet routine dental needs than routine foot care needs. Medicare’s non-coverage of dental care doesn’t affect dentistry’s status one bit. We need to feel no shame in doing routine foot care to reduce pain, discomfort, and risk for our patients.
Jeff Pinsky, DPM, Petersburg, VA
05/01/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Robert D Teitelbaum, DPM
Paul Kesselman's Podiatry Management article about "allopathic" medicine and how DPMs are allopathic doctors was a great lesson in the real meaning and the corruption of common words that we use to describe our professional status. I would also like to bring up three words that have held us back professionally and consistently for 40 years and I have not seen them much talked about. Those three words are "routine foot care".
My thesis is this:
1. There is no complaint about foot pain that is routine. A patient who realizes that her bent 2nd toe has a painful corn on the first joint that hurts in all shoes is in distress. They need someone to counsel them on the choices they may face and the treatments that are relevant. The patient wants our experience, knowledge, and ability to communicate. They want a plan of action--in other words they want...
Editor's note: Dr. Teitelbaum's extended-length letter appears here.
05/01/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1
From: Joel Lang, DPM
When I first opened my practice, I had a great mentor, Dr. Charlie Turchin, a diamond in the rough. He taught me that if I could not earn a living in 50 weeks, working 52 would make no difference.
Another mentor was my practice management professor at the New York College, Dr. Elizabeth Roberts, who taught me to practice on my first day the way I wanted to be practicing 10-20 years later. Don’t start one way, thinking that someday you will change. You probably won’t (though in some ways I did).
Combining these two pieces of advice, I decided that I wanted and deserved a 2-week vacation each...
Editor's note: Dr. Lang's extended-length letter appears here.
04/22/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Paul Kesselman, DPM
It was wonderful to read Dr. Shapiro's first installment on duplex scanning, an invaluable diagnostic test for those providing any wound care therapy or seeing patients with a potential DVT. The loss of invaluable time, especially when dealing with patients with a possible DVT, if left not promptly diagnosed and treated, may lead to loss of life. For patients requiring vein ablations, vein mapping can be incorporated into the study. For those with venous leg ulcers, duplex venous scanning along with other non-invasive testing, can be invaluable for predicting whether conservative therapy (and which one) may be successful. For arterial ulcers and DFUs, arterial duplex scanning complements arterial Doppler, PPG, and PCR along with several other tests that offer insights into microcirculation, thus providing guidance for therapeutic interventions.
These tests can be used as part of an armamentarium to support the use of HBO, hyperoxic therapy, NPWT, and cellular tissue products. All third-party payers are currently scrutinizing several of these...
Editor's note: Dr. Kesselman's extended-length letter appears here.
02/04/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Allen M. Jacobs, DPM
Dr. Orosz is correct; lipedema is yet another potential cause of lower extremity edema. Lipedema is “classically” non-pitting and, therefore in theory, likely less responsive to compression therapy. However, lipolymphedema, like phlebolymphedema, is now a recognized clinical entity. As such, a secondary diagnosis of lymphedema concurrent to that of lipedema may be appropriate, thus qualifying the patient for benefits of the Lymphedema Act and thus helpful to the patient from a psycho-social and physiologic aspect.
Allen Jacobs, DPM, St. Louis, MO
02/03/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Michael Orosz, DPM
I would like to thank Dr. Jacobs for his thorough review of the complexity of evaluation and treatment of lower extremity lymphedema and PVD/PAD. To make things more complicated, podiatrists should also be aware of lipedema as a cause of swelling and enlarged tissue in the legs, thighs, and even the upper extremities. I suggest visiting the Lipedema Foundation website at lipedema.org to learn more.
Michael Orosz, DPM, Cedar Rapids, IA
01/31/2026
RESPONSES/COMMENTS (PM ARTICLES)
From: Allen M. Jacobs, DPM
The recent discussion of the Lymphedema Act and the ability of the podiatric physician to be reimbursed for the dispensing of certain products such as compression garments as an aid for the management of lymphedema is helpful for understanding the economic and coding aspects of lymphedema. However, I believe the clinical issues discussed in this article require a more detailed and accurate discussion.
Editor's note: Unfortunately, this extended-length letter which appeared in the 1/29/26 issue of PM News included only the first part of Dr. Jacob's response. To read the entire letter, click here.
12/08/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: David Secord, DPM
I thought that I’d offer a correction in the published “Implications of Cannabis Use on Diabetes and Diabetic Ulcers It’s important to understand its use in wound healing,” by Zanib Cheena, DPM, MS and Stephanie Wu, DPM, MSC.
In that article, they state that “According to the Center for Disease Control (CDC), cannabis is the most commonly used federally illegal drug in the United States as it is currently legal in 24 states for recreational use and in 40 states for medical use.” Marijuana is still a Schedule I narcotic and is not legal in any State of the Union. It has been decriminalized in these states, but it is still a felony to grow, process, sell, and distribute or possess this...
Editor's note: Dr. Secord's extended-length letter can be read here.
08/25/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Rod Tomczak, DPM, MD, EdD
I have two daughters who are physician extenders, but I can’t simply define what a physician extender really is. Ludwig Wittgenstein, an analytical philosopher, said in 1953, “The meaning of a word is its use in the language.” That certainly clears it up.
It seems an extender is now able to perform a task or interpret some evidence and act on it in a realm that previously was limited to a physician. A CRNA provides anesthesia for our patients. They act independently except during induction and emergence when the anesthesiologist is required to be present in the operating room according to most state laws. You and I know that is not always the case. State laws limit the number of ...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/22/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: James Hatfield, DPM
I enjoyed reading Dr. Jon Hultman’s article in the August 2025 Podiatry Management. I couldn’t agree with him more. Podiatry has missed the boat or has been late for the boat historically. Let’s talk about radiology. No podiatrist would think of practicing without x-ray facilities in their office now – but it wasn’t always the case. We’re all familiar with Dale Austin via his bunionectomy (technically the Austin-Leviton bunionectomy - or Chevron, if you’re an orthopedist). Dale Austin was a podiatrist in the Los Angeles area in the 1950s and decided to do something really radical. He was the first podiatrist in the state to have an x-ray machine.
You’d think the other podiatrists (then chiropodists) in the area would applaud him – but just the opposite. They were appalled and angry. They were afraid that the orthopedists who sent palliative care to them would stop referring. Dale Austin became frustrated by this response and decided to go back and become a DO. Then, in 1961, via legislation, the DOs agreed to merge with the MDs in California, so he became an MD, though he still practiced primarily foot care. Too bad for podiatry.
Dr. Hultman is right about having a form of certified podiatric hygienist in the office. There’s a huge number of palliative patients who will need surgical services at some point and it would obviously be optimal if these patients could be cared for in a podiatry practice rather than somewhere else. And, as Dr. Hultman pointed out, it pays. Let's not miss the boat again.
James Hatfield, DPM, Encinitas, CA
08/16/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Elliot Udell, DPM
Dr. Kaufman asks a pertinent question. If podiatry schools are not filling their classes, why are new schools opening? Why are they staying open?
Podiatry colleges are independent entities. Some are private and others are part of large universities. No one can wave a wand and decide to close any of these schools. If a class is not filled but the university or college is making out well financially with tuition and donations, there is no incentive for them to close, even if they only have "five students." On the other hand, if the finances of these institutions "go South," they may be forced to close, and here again, no one in our profession will have any say over that decision.
Elliot Udell, DPM, Hicksville, NY
08/15/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Heather Kaufman, DPM
I read "Our House is On Fire!" (June/July 2025). I am wondering if anyone has addressed the elephant in the room which is that if the numbers are going down, then why in the past five years have new podiatry schools opened? LECOM opened their podiatry school in 2022 and UTRGV opened theirs in 2022 as well. If the numbers were low to begin with, why dilute the dwindling applicant pool further by adding more seats to fill? If our house is on fire, we lit the match ourselves.
Heather Kaufman, DPM, Anchorage, AK
07/16/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Lawrence Rubin, DPM
A few weeks ago, I read a convincing article in Podiatry Management Magazine that portends podiatry's potential demise if there is continued low matriculation of students in our colleges. Then, a few days ago, I saw a LinkedIn post from APMA in which podiatrists attending a major convention were celebrating the fact that podiatry has never been more viable and successful than now and can look forward to a marvelous future.
While I have deep feelings wanting APMA and these podiatrists to be right, something tells me that we should not ignore our failure to attract students and the possible adverse consequences of this occurring.
Lawrence Rubin, DPM, Las Vegas, NV
07/04/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Joseph Borreggine, DPM
The recent article on the Stark Law is very important and informative for all medical providers to read and ultimately understand with respect to the day-to-day operations of running a medical practice, working cooperation as a medical referral source, as well as being an employee in a more than two person (group) medical practice. This law is meant to not only protect the Medicare system from fraud and abuse which can be deemed direct or indirect but also provide government regulation and guidelines preventing physicians from being paid inappropriately whether in a small group or larger corporate practice setting.
I commented on this subject a while ago in this publication and did not get one response; either because 1) every reader was either fully knowledgeable of what I was talking about or 2) was completely ignorant of my comments with respect to payment for “designated health services” (DHS) in a group...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
07/03/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Paul Kesselman, DPM and Larry Kobak DPM, JD
In the June/July 2025 issue of Podiatry Management, the Legal Corner provides an excellent synopsis of Stark Law and how it can find its way into everyday podiatric practice. There is one point (Number 5), however, which requires clarification. Regarding DME, it states, "If you own a durable medical equipment company and refer a patient to that company," this could potentially be a Stark violation.
Providing DME to your own patients in your podiatry practice is an allowed exclusion under Stark, just as taking x-rays of your own patients is an exception under Stark. Further clarifying is that you and the doctor must perform the service. You cannot have someone in your office dispensing the DME, in particular if the DME is a designated health service, as AFOs, for example, are. Furthermore, if your employees are assisting in providing any designated health service (DHS), they must be performing this under your direct supervision, while you, the doctor, actually are in the office. There are certain DME (e.g. surgical dressings) which are not DHS, and all the Stark rules may or may not apply.
Furthermore, if you do own a legally identifiable DME company with a separate tax ID from your practice and you refer your patients there, that may be problematic. Under these circumstances, it is highly suggested that you consult with a healthcare attorney to ensure you are in compliance with all Federal Stark and Anti-kickback regulations. There are also other regulations, including state licensing requirements, facility accreditation, and surety bonding that likely will apply here, which again like Stark, DO NOT APPLY to physicians providing DME to their own patients as part of a treatment plan and within their scope of practice.
Paul Kesselman, DPM, Oceanside NY, Larry Kobak, DPM, JD, NY, NY
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