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02/29/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: David Secord, DPM
One aspect of the current surfeit of schools of podiatric medicine we should consider is how an average applicant pool being diluted by so many schools weakens the whole. I can only speak of Temple, as I am good friends with someone who instructs there and reveals that the number of applicants and the number of admitted students is too low to sustain a tuition-driven institution.
I understand that at some point Temple University dropped the hammer and let the school of podiatry know that it has to start being a neutral entity and not be financially subsidized to keep it afloat. I know of no established time frame, but if Temple may be contemplating the long-term fate of the Philadelphia school (my alma mater) I can only imagine that...
Editor's note: Dr. Secord's extended-length letter can be read here.
Other messages in this thread:
08/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Keith Gurnick, DPM
In my office, I keep a small box filled with used, worn out or broken instrument spare parts, and screws from broken tissue nippers and nail trimmers with broken springs. Often, when a spring breaks on a tissue nipper or a toenail clipper, I can easily replace the broken part quickly and simply with a similar part that I saved, and am able to locate in the box. Otherwise, the broken instrument goes into the box, or into the trash, and I will purchase new ones.
However, if you have broken two out of four new nail nippers, either the quality of the nipper is poor (Pakistani stainless steel vs. German stainless steel) or you are using too small of a clipper on too thick a toenail, or you may be heavy-handed or rushing, or you might just need a larger nail clipper, or you may need to "adjust" or "modify" your toenail clipping technique.
Keith Gurnick, DPM, Los Angeles, CA
07/31/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
Thank you, Dr. DiResta, for pointing out the fact that APMA discontinued their sponsorship of the Dartmouth MPH program. I was totally unaware of that, but the fact remains that when it was in place, it provided graduates who went onto non-clinical careers or it simply improved those individual's status in whatever clinical programs they were involved with. Now that Becker's has published the story I wrote about where both MD and DO programs are offering dual programs for medicine and MPH or MBA, perhaps it is time that APMA reassess its importance. Perhaps APMA, if it cannot afford to sponsor this program itself, can partner with other private enterprises which have profited from podiatry well over the years to offer such scholarships to individuals interested in one of these programs.
I have been made aware for some time that APMA has serious financial issues. Having been a member of various committees over the years as well as...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/30/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Dr. DiResta gets it! It's not because he mentions me or my ideas about the DO path to an unrestricted license but because of his observations concerning the DPM degree NOT being a starting point to move forward. It is a starting point to move laterally. You can have an MHA, MPH, or a PhD in healthcare, but try to aspirate a knee and see how far a master's degree gets you.
Get the DO degree, then enough ACGME-approved residency time to get an unrestricted license, followed by an APMA fellowship in podiatry from Temple, Touro, LECOM, DMU, or UTRGV. Now you can move forward from your starting point.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
07/30/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: William Wayne Egelston, DPM
I too enjoy the posts in PM News. Whether one agrees with the authors or not, doesn't detract from their insightfulness. I appreciate the dialogue presented by Drs. Kesselman and DiResta and others on this topic. Considering how things are evolving for podiatrists with diminishing numbers of qualified (academically prepared) applicants, likelihood of schools (some or all) closing and increasing number of MD/DO schools on the horizon. It would seem to me a likely scenario might be that future applicants matriculate to MD/DO schools (domestic/foreign), complete orthopedic residencies and foot and ankle fellowships (or others), then train physician extenders (LVN, RN, NP, PA, etc.) in C&C, nail care, and primary podiatry. I see this as a more plausible pathway than watching our decline and obsolescence.
I see this as I, along with other DPMs at Kaiser (California), functioned in...
Editor's note: Dr. Egelston's extended-length letter can be read here.
06/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1B
From: Ivar E. Roth, DPM, MPH
Kudos to Drs. Tomczak and now Saxena. I have written this in PM News before without any evidence, but as told to me from my son who recently graduated. He said a good number of students in his class should never have been allowed to be accepted in the first place. A fair number dropped out after the first and second year, but he felt that there were many in his class that just graduated who were barely hanging on and probably should have been weeded out.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
06/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1
From: Amol Saxena, DPM, MPH
Mic drop for Dr. Tomczak! Makes me think of the Jack Nicholson line, "You can’t handle the truth." Promoting podiatry is one thing and lowering standards to fill seats is another. Kudos to him for doing the research and pointing out the current data available.
Amol Saxena, DPM, MPH, Palo Alo, CA
05/29/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Do We Really Have a Medical Degree (Allen M. Jacobs, DPM)
From: Gary S Smith, DPM
I agree with Dr. Jacobs that a 3-year residency can make a huge difference in surgical skills. The problem is that according to PM News surveys, the majority of podiatrists don't do ORIF of ankle fractures and don't want to. Many people go into podiatry to practice podiatric medicine and not orthopedic surgery. This is no longer an option to them. With the mandatory 3-year program, it's just not logical to do the same time in training of MDs and DOs with unlimited specialty options when podiatrists only have one.
The 3-year residency, once a premiere program ensuring excellence in training is now like a high school diploma. Everybody has one. I have seen 3-year graduates who could not do a hammertoe arthroplasty or even a matrixectomy with competence. I would also like to point out that because of this generic requirement, podiatrists like Dr. Jacobs cannot get privileges at many hospitals today.
Gary S Smith, DPM, Bradford, PA
05/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: James Hatfield, DPM
At the end of the day, I ask myself if I enjoy what I did in my practice - Yes. Was I as busy as I needed to be? - Yes - I was booked up for 2 months ahead. Did I make a good living? - Yes - equivalent with most of the physicians in the area. Did I need to do better? – No. Did I have good privileges at the local hospital - Yes, full scope available. Did I do my own H&Ps – Yes. Did I get referrals from the local MDs? - Yes, lots. Did the MDs call me "Doctor"? – Yes. Did the patients call me "Doctor”?- Yes.
Anyone who needs more than this has an inferiority complex. Podiatry is consistently rated as one of the highest paying jobs in the U.S: #19th by U.S. News & World Report: Any student who can't be happy considering podiatry as a career is foolish.
James Hatfield, DPM, Encinitas, CA
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Allen M. Jacobs, DPM
Arden Smith reminds those of us from Philadelphia of his appreciation of Louis Newman and "Buzz" Forman. Both of these were also mentors of mine. When I was working in the OR at Kensington Hospital in Philadelphia, I was fascinated watching Dr. Forman teach podiatry students on clinical rounds. He went on and on questioning and educating the students. He was not a paid faculty member of the college. If I recall correctly, he was one of the first ACFAS members with a very low number on his certificate. He was devoting his time to advancing our profession with no financial award. I was very young working as a patient transporter from the room to OR and back. I remember how shocked I was watching him remove 10 toenails, thinking OMG! I watched him do forefoot surgery, always teaching. That is how you advance a profession.
Louis Newman was a dedicated surgical educator. I worked with him at Oxford Hospital and Rolling Hill Hospital in Philadelphia. He would take the students to lunch, educate us over a meal, direct and build our skills in the OR, then spend time with us after cases...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 3
From: Charles Myers, DPM
In my area, there are a fair number of providers outside of podiatry and the wound center of doctors performing wound care. Orthopedic doctors, general surgeons, and family medicine doctors over the last couple of years are wound care specialists now and billing Medicare.
Many of these applications are now being applied at home and being billed by doctors who never made home visits before. And yes, Ortho is doing wound care in my area. I can't help but feel that much of this is money driven.
Charles Myers, DPM, Conway, SC
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell DPM)
We need to be honest with ourselves. Comparing our profession to dermatology and orthopedics to show that there is nothing wrong with teaching nurses how to practice general podiatry is unfair. Why? Every dermatologist and orthopedic surgeon knows that the overlap between what we do and what they do in their practices is small. We do not operate on knees and hips nor treat skin disorders above our anatomic ranges of practice. On the other hand, everything a podiatrist does can be duplicated by someone in the MD and DO worlds.
I suspect that Dr. DiResta's concern is that MDs and DOs choose not to practice non-surgical general podiatry. If we train nurses to do what almost all of us do most of the time, why would they send us any of their patients for foot care? They can hire a nurse to render all general foot care and profit from it. Taking it one step further, nurses and PAs can be trained to do most of the foot surgeries we do, but we probably don't have to worry about that in a few years to come.
Elliot Udell, DPM, Hicksville, NY
02/07/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Ivar E. Roth, DPM, MPH
Dr. Rubin has hit this nail on the head. All we need is a group of “thought leaders” to come up with some solutions here. I do not feel it is the APMA that we should turn to. If they have not done this to date, there is a reason. I believe we need some real “in the trenches” DPMs with experience in life, and I for one, would volunteer to help out. We have so many problems going on concerning our future.
I recently spoke with a recent residency graduate who did a three-year surgical program, and he said no one from his program ever did a case skin-to-skin in the three years of training. How is this possible? He said he is too afraid to say something as he is early on in his career and does not want to make any problems. I am just dumbfounded that no one has spoken up. If others reading this post are moved to be part of the “thought leaders” let’s hear from you and hopefully we can do something positive together.
Ivar E. Roth, DPM, MPH, Newport Beach,, CA
02/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Alan Sherman, DPM
Sometimes it is hardest to see that which is right in front of our faces, and particularly, if it has been growing there for some time. Allen Jacobs is right. While it is not the only factor, our devaluation of the name podiatry IS hurting applications to podiatry schools and general awareness as to what a podiatrist is. We should rethink this. Either we complete the process of becoming foot and ankle specialist MDs or we go back to using the term podiatrist and be the DPMs that we should be.
I continue to strongly believe that we need dual track residency education - a surgery track for the minority of residents who are deemed to be suited to be specialty foot surgeons and a medicine/general track for the majority of residents who will practice general podiatric medicine and wound care. One will refer to the other to provide complete care of the foot and leg.
Alan Sherman, DPM, Boca Raton, FL
01/17/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Alan Sherman, DPM
The ever thoughtful and astute Rod Tomczak, DPM opines on the reasons for the declining applicants to podiatry schools. I agree that the huge numbers of spots that have opened up in DO schools and the innumerable offshore medical schools have provided a more attractive option for many that might have considered podiatry school. We should all have the patience to accept the things that we cannot change. But I am more concerned about the fact that we have come to REQUIRE that ALL PODIATRISTS be 3-year trained surgeons. I have been saying for years, and I believe that we will come to learn, that we have made a big mistake by single tracking all podiatrists into this one training program. By doing so, we have eliminated from consideration many of the candidates that have no interest in surgery or don't think they are well suited to be surgeons.
Why are we putting any future non-surgical podiatrists through 3 years of rigorous, demanding surgical training? To stress them? To test their mettle? Do we truly no longer want non-surgical podiatrists? I personally can't imagine a podiatry profession without non-surgical podiatrists. Apropos to this, see Jarrod Shapiro's Practice Perfect 945: Surgical Versus Non-surgical Podiatry: Should There Be a Separation?
Alan Sherman, DPM, Boca Raton, FL
12/16/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From Jon Purdy, DPM
It goes without saying that this is a tragedy regardless. The other tragedy is the root cause of what led to this, and that started with the inception of Medicare. It is, and always was, destined to be insolvent. Medicare does not function as originally promised, and now is tinkering with the system, partnering with private plans. The not so unintended consequences are seen in everyday practice and patient care.
Can anyone name a program the government runs that is fiscally responsible and works well? If the working class were allowed to keep and invest the money the government takes from them their entire working lives, an individual would have a million plus dollars to spend as they see fit on their healthcare. This ownership inevitably necessitates responsibility. One would be able to afford their own insurance premiums and pass what is left to their own families. The government in all its wisdom has farmed out Medicare allowing for further corruption, as has been eloquently outlined numerous times by Dr. Kesselman.
Medicare effectively pulls millions of people out of the free market affecting the price and function of private plans. It is not subject to market forces such as they demand a quality and cost-effective product to stay in business.
Jon Purdy, DPM, New Iberia, LA
11/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Charles Morelli, DPM
I'd like to echo Dr. Roth's sentiment and experience when it comes to the fact that "the medical billing rip-off is rampant in medicine and podiatry." Yes, every profession has their bad actors, but sometimes you come across with a story that makes you shake your head. I'll try to be brief.
A patient was seeing the same podiatrist every 6 weeks, for over 22 years. He was treating her for a chronically ingrown nail, was cutting the corner of her nail, charging her the $25.00 co-pay and I imagine also billing her insurance carrier. She called one day for an appointment and asked to be seen as she was in pain, and felt it was an emergency. According to the patient, no matter how hard she pleaded, she could not be seen and...
Editor's note: Dr. Morelli's extended-length letter can be read here.
11/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Adam M Budny, DPM
I read this post earlier today and quite honestly I was perplexed, as I am one of the "insurance podiatrists" who I believe represent the majority of the profession, as opposed to a boutique/direct pay" podiatrist (which seems to be Dr. Roth's implied practice model?). I see nothing wrong with billing a new patient visit or x-ray as a diagnostic study. How else would a practice run if you did not bill new/established visits of one sort or another?
Specifically, in my experience and clinical practice, stretching exercises are actually the mainstay of management for plantar fasciitis, and all of my patients are given literature and a home exercise program (HEP) for performing this at their initial visit. Regarding shockwave therapy, this is also a well accepted treatment option per the American College of Foot and Ankle Surgeons Clinical Consensus...
Editor's note: Dr. Budny's extended-length letter can be read here.
11/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Jon Purdy, DPM
I had a similar frustrating experience when I sent myself for my first routine colonoscopy. I was told an exam was necessary and received one from their PA. A little palpation here and there and an order for stool examination. To my protest, I was told the doctor will not do the procedure without it. I complied and received my first bill for a CPT 99204. I questioned the validity of that exam level with the office manager to no avail.
On the day of the procedure, the doctor asked if I was ready and said they would be taking me back. I said what about my results? He looked confused. I told him I was told he would not do the procedure without the stool path and he said “that is not true.” So I underwent my procedure irritated about the entire process thus far. In recover the doctor said, “everything looks great, but there was one spot of inflammation I needed to biopsy.” It was a “Where’s Waldo” game to discern anything in the photo, but I know that extra $350 comes in handy.
So they made some good money on me while I was stuck with unnecessary bills, frustration, and inconvenience. This just verified to me of what is out there, and what I do not do to my patients.
Jon Purdy, DPM, New Iberia, LA
11/15/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Hilbert, DPM
I receive the healthcare provider discount from AT&T. When I switched from Verizon a few years back, the "in-store" rep asked my profession. I told him that I am a podiatrist. I have received the discount ever since.
Paul Hilbert, DPM, Navarre, FL
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Lawrence Rubin, DPM
A recent post in PM News pertaining to insurance reimbursement compliance said, "Any abnormal findings on the LEAP Vitals Exam, i.e. dry and xerotic skin (L85.3) caused by sudomotor dysfunction, is a significant risk to a patient with diabetes. It therefore warrants a care plan." To prevent confusion of business names, this is not a stated opinion of the 501(c)3 not-for-profit LEAP Alliance.
Lawrence Rubin, DPM, Las Vegas, NV
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Paul Kesselman, DPM
I stand by my partner Alan Bass, DPM, whose opinion is absolutely correct. Each patient encounter should have at a minimum an appropriate history and physical with components of lower extremity systems including but not limited to dermatology and must also include neurovascular and a MSK examination. Any changes in patient history or PE should be well documented and incorporated into the note.
But the change in history is not what will get you paid for a separate E/M nor is documenting a change in the physical examination. It is that last part, the management, what exactly did you do? If all you did was document a change in history, nope. If all you did was document a change in the PE, again, no dice. You must document all 3 issues, ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) PART 2
From: Michael J. Schneider, DPM
I would like to add my congratulations to SuEllen and David on their retirement. I had used their products throughout my career. When I retired and began volunteering at the Denver Rescue Mission, SuEllen and David donated Gordon Labs products for my patients. Good Luck on your retirement!
Michael J. Schneider, DPM, Denver, CO
10/16/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Ron Freireich, DPM
If APMA promotes an Annual Comprehensive Diabetes Prevention Foot Examination, I hope they also promote that the exam is not covered by insurance, unless things have changed since this issue was also brought up in a post on PM News back on 07/09/2021.
It should be a covered exam just like an annual eye exam for at-risk patients, which would save limbs and lives not to mention save money for insurance companies. First things first. Get insurance companies to cover the exam, promote it, and then we'll be more than happy to perform them.
Ron Freireich, DPM, Cleveland, OH
09/30/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Bret M. Ribotsky, DPM
It’s time to really look at the APMA budget and see where money can be re-allocated. Currently, $290K is spent on advertising, and $457K on pensions of employees - True Marketing/Advertising has never been more reasonable - Social Media, DPM influencers, etc. should be tried.
So here’s a few ideas for APMA to consider re-allocating money and I’d love others to make suggestions:
1) APMA - exit the seminar business, and leave it to others; this, will leave significant money available. Currently $750 thousand was spent last year.
2) Limit travel of board members to regional/state meetings and use telecommunication to allow more members to get involved. $1.2 million was spent on travel last year.
Bret M. Ribotsky, DPM, Fort Lauderdale, FL
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ron Werter, DPM
What I don’t understand (and maybe the lawyers among us could explain) is how does the insurance company have the legal right to charge the doctor for writing a prescription. The doctor has no financial stake in the prescription; the patient and the pharmacy are the ones who have financial benefit. Is there something in an insurance company contract that says they can do that?
Ron Werter, DPM, NY, NY
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