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01/11/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Why The Podiatry School Applicant Pool is So Small
From: Elliot Udell, DPM
This topic gets bandied around every year. The current survey on PM News may lead to some answers. At this moment 18% were either somewhat dissatisfied or not at all satisfied. 37% are only somewhat satisfied.
An astute pre-med student who will be facing 7 years of training and a mountain of debt may have difficulty choosing podiatry after looking at this survey. What are the main areas bothering practicing podiatrists? Once we know and acknowledge each area of deficiency, we can begin to repair the problems. Only then will this lead to far more attendance at our colleges.
Elliot Udell, DPM, Hicksville, NY
Other messages in this thread:
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
01/16/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Rod Tomczak, DPM, MD, EdD
Is it? Probably, with 37 DO schools now open in the U.S. and Caribbean medical schools on the rebound after COVID to more than 50. Some Caribbean schools will accept just about anyone with tuition and boast a 95% Step 1 USMLE pass rate. They can make that claim because they only certify their better students who have a 95% predicted pass rate based on NBME practice tests to take Step 1. In most Caribbean schools, a high percentage of students are foreign. When I was in Riyadh opening a medical school there, the country of 35,000,000 had one American-trained podiatrist in Jeddah, Saudi Arabia which had a population of 5,000,000. Saudi Arabia is rampant with type 2 DM and this gentleman was revered for saving limbs instead of amputating.
AACPM states there were 1,000 applicants to podiatry schools for the 2023-2024 academic year and 711 students matriculated. That’s a 71% application to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
01/16/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Ron Freireich, DPM
When physician Medicare pay has decreased by 29% since 2001 - When only 42.86% of podiatrists are very satisfied with their careers - When the CEO of a 354-bed hospital where I am on staff recently stated in a newsletter, "Our operating margin continues to be negative due to lower reimbursement rates and higher operating expenses" meaning the hospital continues to LOSE money - When a recent article in Medscape reported that 49% of physicians surveyed feel burned out, and the NPs and PAs that were to help take stress off the physicians are now also complaining of burnout.
When a family member who recently went to the ER of a 193-bed hospital was diagnosed with pneumonia but could not be admitted because there were 80 other patients waiting to be admitted (several wings were closed due to staffing issues and two other nearby hospitals have closed within the last several years, overwhelming this hospital)...
Why would anyone want to choose a career in medicine when doctors and hospital insurance reimbursements continue to decrease, less than half of podiatrists are very satisfied with their career and almost 50% of physicians, PAs, and NPs are reporting burnout? It's not just the small podiatry school applicant pool we should be worried about. In my opinion, the whole medical system is imploding.
Ron Freireich, DPM, Cleveland, OH
01/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Vincent Marino, DPM
I may be reading this incorrectly, but it seems to me with the enactment of this new law, the medical community will no longer be able to go after patients for unpaid medical bills since collection companies will no longer be able to ding the patient’s credit report for outstanding bills. Good luck collecting balances. I suggest everyone start collecting the day of service even if you have to refund the patient.
Vincent Marino, DPM, Novato, CA
01/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Scott Steinberg, DPM
Podiatrists willing to share their offices with colleagues who lost theirs and possibly their homes should contact the California Podiatric Medical Association (CPMA). Podiatrists who lost their offices should call their office phone company to forward the number to their mobile phone. Other associations might want to consider making donations to CPMA so they can, in turn, provide loans to affected practices.
Robert Scott Steinberg, DPM, Schaumburg, IL
01/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Start with Why
From: Mark Hinkes, DPM
I have just finished reading Start with Why by Simon Sinek. He also has a TED lecture. The book has changed my life....and I recommend it to anyone who is looking for their path forward. As I read all of the comments concerning the fate of podiatry as a profession, the thought has come to me... The general public does not know the "Why" of podiatry, and our profession has failed to explain that to the public.
We have been telling people the "How" it could benefit their health and "What" we can do for them but this approach usually fails because we have not aligned people's beliefs to those of our profession. A better approach might be to explain "Why" podiatry is the best profession to provide foot health services. What is our Why? Is it our education? Is it the research we do? Is it the post-graduate training that every student receives? Is it the special tools we use?
What is our "Why"? I challenge those reading this to share what they believe is the "Why" of podiatry.
Mark Hinkes, DPM, Nashville, TN
01/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Allen M. Jacobs, DPM
The reasons for a declining applicant pool to the colleges of podiatric medicine are multifactorial. There is need for some reality discussion. Years ago, there were somewhat limited alternative options for those who desired to enter healthcare as a provider, but were, for whatever reason, not accepted into medical school. There were few island medical schools, few colleges of osteopathic medicine. There were no PAs or NPs. There was always dentistry, physical therapy, optometry, chiropractic medicine. Competition to medical school is intense, and there are many excellent individuals who fail to succeed in admission to medical college in the United States.
It is not a matter of failure, it's a matter of numbers. Those who argue that diminishing reimbursement for services is the reason for declining applicants should ask why this factor has not reduced applications to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
01/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Federal Watchdog Agency Bans Medical Debt from Credit Reports
From: Keith Gurnick, DPM
Rohit Chopra, President Biden's Consumer Financial Protection Bureau director, has rolled out another controversial new regulation. This week, the watchdog agency finalized rules that bar unpaid medical bills from being included in consumer credit reports, thus removing another existing tool (or threat) that doctor's offices and collection agencies have used for years to get paid from patients who owe money after their claims have been processed by their insurance carriers.
"People who get sick shouldn’t have their financial future upended,” Chopra said in a statement. “The CFPB’s final rule will close a special carve-out that has allowed debt collectors to abuse the credit reporting system to coerce people into paying medical bills they may not even owe.”
Republicans have hinted they may try to undo some of Chopra’s moves using the Congressional Review Act, which allows lawmakers and the president to spike recently completed rules. What’s more, the law bans agencies from enacting new regulations that are “substantially the same” as one Congress has reversed — meaning they could, in theory, be permanently repealed.
Source Jordan Weissmann, Yahoo Finance [1/7/25]
Keith Gurnick, DPM, Los Angeles, CA
01/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Los Angeles Fire Devastation
From: Richard A. Simmons, DPM
We have all watched the devastation of many communities of Los Angeles. Unfortunately, this means the total loss for many of our colleagues. This is one of those unrecoverable losses for almost a generation of a medical practice. I hope that there is some kind of GoFundMe or other plan set up for our podiatric brothers and sisters.
Richard A. Simmons, DPM, Rockledge, FL
01/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ivar E. Roth DPM, MPH
Based on the recent concerns about attracting students and making a living, I would like to throw a life raft out to the future podiatrists and the current ones as well. To be successful as a concierge podiatrist, I have had to offer services that no one else offers or services that many might think is below them.
Let me start off by saying I offer medical pedicures. I consider myself an expert in the old world of performing C&C. We get approximately 2 to 3 new patients every day. While we charge cash, and the fee is rather low, we offer a very needed service that people want and need. A certain percentage of these patients need and will pay out-of-pocket for other services, most commonly orthotics and fungus nail treatments.
Ivar E. Roth DPM, MPH, Newport Beach, CA
01/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Robert Kornfeld, DPM
Dr. Udell asks, "What are the main areas bothering podiatrists?" I think this cannot possibly be in debate - it is the ridiculously low insurance reimbursements and the insane prior approval hurdles. Most podiatrists that I speak to enjoy treating patients. But they ABHOR what they are required to do and how little they get paid after so much training and experience.
I am PGY-44. The issues have not changed. We have been battling insurance companies for decades and LOSING. Continued negotiations will not make anything better. Just look at your Medicare reimbursement levels for 2025. Is there any other profession that continually has its earning power diminish year after year?
So here I am again...encouraging those who really wish to enjoy practice autonomy and eliminate the middlemen to stop telling themselves they can't create a successful direct-pay practice, or at least a hybrid practice. You absolutely can! Your current patient population is not who will honor you with direct payments. They come to you because you accept insurance. But there are thousands of patients in your area who are completely fed up with the system. And they definitely will come to you with the right branding and marketing. Remember, anything you tell yourself becomes your reality.
Robert Kornfeld, DPM, NY, NY
01/03/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Rod Tomczak, DPM, MD, EdD
In 1976, I was beginning my third year of podiatry school, the United States was celebrating a bicentennial, Jimmy Carter was running for the presidency, many of today's practicing podiatrists were not born yet, and Carter gave an incredibly controversial interview with Playboy magazine that was published before the election.
In the interview he candidly admitted he had “…looked upon many women with lust,” and “…committed adultery in his heart.” After the election, he said these quotes almost cost him the election, but in reality, he probably edified as many voters as it alienated. Carter was a Southern Baptist deacon and was referring to the new testament Gospel of Mathew where, “ …an offending thought was equivalent to a consummated adultery.” And, Carter said, “I have committed adultery many times in my...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
01/02/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Ivar Roth, DPM, MPH
A clarification is needed here. My statement stated that if one took fellowship training, they could do these surgeries. This would not be a weekend course but a real fellowship one or two years. Obviously, sometimes things can get out of hand, and that is when you contact or make the appropriate referral. Why not? Let’s support our own specifically trained podiatric vascular specialist; it will be good for all of us.
Ivar E. Roth DPM, MPH, Newport Beach, CA
01/02/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Alternatives for Gordon Products (Elliot Udell, DPM)
From: R. Alex Dellinger, DPM
I have been happy with products from EBM Medical. They have dry skin products, antifungal products, supplements for diabetic neuropathy, and many other products. All their products are cash pay - about what a mid-level co-pay is. They allow you to "virtually stock" items. You "prescribe" them for your patient through their portal and the item is then shipped to the patient's home in about 48 hours. You make the delta between the wholesale and retail price (you can set your own retail price). They have great product support and a great web portal. Evidence-based therapies at affordable prices.
Disclosure: I have no financial interest in EBM Medical.
R. Alex Dellinger, DPM, Little Rock, AR
01/02/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Over-Training and Under-Thinking
From: Rod Tomczak, DPM, MD, EdD
I remember quite vividly completing my residency which jammed a lot of learning and doing into two years, then starting practice in Monroe, MI. For the first few months, my patients were being admitted under my name alone, something not usually done in Philadelphia or Cherry Hill, New Jersey in the 1970s. I said nothing, did my own H&Ps, wrote all admitting orders, and continued writing the systemic medications patients were taking. It was a matter of ego once the policy started. I thought I could manage patients’ co-morbidities up to a point. This small town had no anesthesiologists, and the anesthetists were comfortable with my assessments, orders, and management of slightly ill patients.
Then I was informed Michigan state law mandated an MD or DO co-admit. I guess I felt humiliated that my abilities were being questioned by a diabetic, obese, smoking RN administrator. I was angry and had no right to be. I went so far as to claim my physical examination skills were on par with...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
01/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Elliot Udell, DPM
Dr. Roth, once again asks why we as podiatrists cannot be trained to do procedures such as spinal stimulators and stents to treat PVD.
There is no doubt that Dr. Roth and most DPMs are smart enough, with proper training, to do these procedures and do them well. It all boils down to legality. Dr. Roth states that he spoke with legal counsel who said, "If the law says we can do it, why not?" The obvious question is what the law in each locality will and will not allow concerning surgical procedures done way above the ankle which directly affect the treatment of pathology in our anatomic scope of practice.
In essence, our ability to perform these procedures will probably be decided by state legislatures and courts, and we should not expect state medical societies to stand by idly and watch us take these procedures from their members.
Elliot Udell, DPM, Hicksville, NY
01/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
Ten or twelve years ago, the television was inundated with commercials for Laser Spine Surgery Institutes or similar organizations. One of the entrepreneurs wanted to establish a program in Belize as a medical tourist destination center. It was short lived. Malpractice claims in the U.S. skyrocketed. The surgery was performed endoscopically and any doctor who wanted to be trained and work for the company could. Patients showed up with $30,000 or so in hand to turn over to the company because no insurance was accepted. Since radiculopathies and painful feet along with foot drop affect patients, we can assume California podiatrists could have been trained to perform the procedure. Unfortunately, non-spinal surgeons were not trained to address the surgical complications resulting in deaths and paralysis. They make intra-operative neurophysiologic monitors to alert board certified neurosurgeons of impending disaster. But a weekend course should obviate the need for that. There is at least a day’s worth of reading concerning the topic on the Internet.
Dr. Roth, I would not feel very comfortable performing a stent placement in the Fem-Pop area of the leg because you and your podiatry friends think it’s OK. You cannot possibly believe that you folks define and interpret the law. The opinion of the CPMA attorney makes it legal? It is an opinion. You know that old saying, “opinions are like mouths; everyone has one.” If the California Supreme Court felt stent placement was within the legislated definition of podiatry in California, that may be another thing. Stent placements have been known to go wrong and the vessel ruptured. Are you and your DPM friends prepared to perform a Fem-Pop arterial repair, anastomosis, or insert a new surgical graft? I realize you have not had to address many complications, but there are surgeons who have.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
12/31/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Ivar Roth, DPM, MPH
I have to agree strongly with Dr. DiResta. We as a profession need to think out of the box. Here in California, our license allows us to treat any body area that is related to a foot or ankle problem. Dr. Jacobs criticized my thinking recently when I suggested that we as a profession could implant a device in the spine for severe foot/lower leg neuropathy. I suggested that we be trained just like the MDs in the course that is offered by the company to practicing MDs that have not been trained to do these procedures, and then start doing the procedures. Why not?
I have spoken to other like-minded pods here in California and they agree with me that it is legal and doable. I spoke to our legal counsel here representing the CPMA and they agree that if the law says we can do it, why not? Another example is stenting of arteries in the lower leg for PAD problems. There is no reason why a fellowship should not be started; those DPMs who are trained can do these procedures. I believe it is only a matter of time for our profession to be able to do these procedures once we are trained.
Ivar Roth, DPM, MPH, Newport Beach, CA
12/31/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Rationale for Podiatrists Ordering Urine Dipstick Tests
From: Daniel Chaskin, DPM
If a pedal condition of PVD warrants Doppler studies or an evaluation of the circulatory status of the entire lower extremity, then perhaps in the case of bilateral edema, a podiatrist could order a urine dipstick. Diagnosing the systemic cause of conditions such as bilateral edema enables us to be able to refer to the proper specialist such as a nephrologist.
Daniel Chaskin, DPM, Ridgewood, NY
12/21/2024
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1A
From: Jon Purdy, DPM
I agree with Dr. Kesselman that people are far too undisciplined to manage their long-term care. The government is certainly not capable of that either, as can be seen with insolvency of Medicare and Social Security. The government is not a safety net, it is a burden on society. The government does not invest the monies, they spend it. And, at the end of life they keep YOUR money! In addition, instead of returning your money, they charge you more, with a 20% co-pay, annual deductible, increasing denials, and no free medications. Both of these programs can be taken from you should the government decide. How is that working for everyone?
What I was referring to has far too many details to go into on this forum, but suffice it to say, this would be one mandate I would be in favor of. The mandate to deduct and invest the monies until retirement, at which point a person would have millions. The other benefits of this are passed on as family wealth, a huge spike in the market and economy, as well as more money to spend as you see fit in retirement.
Jon Purdy, DPM, New Iberia, LA
12/21/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: James DiResta, DPM, MPH
If there is one lesson to be learned from these recent blog entries, whether overtly stated or implied, and I might add from some of our most esteemed colleagues, it is the stupidity of suggesting that we ought to "stay in your lane". If podiatrists of my generation stayed in our lane, we would be nowhere. We have come this far because we were willing to buck the system and work to improve our profession beyond the instruction we received. I anticipated that those coming along behind me would expand our scope further and not be satisfied with the status quo.
If we fail to move this profession forward and expand our scope to practicing more general medicine, we will be extinct in a very short time. The walls are closing in on us. Why are we committing ourselves to being stuck in our lane? It is unthinkable that our 4-4-3 model of education has limited us to treating only the local manifestation of...
Editor's note: Dr. DiResta's extended-length letter can be read here.
12/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Paul Kesselman, DPM
Once again, the insurance industry has sent the exact wrong message to the public. Rather than take this murder as a wake-up call to them to respond to the public's need for more transparency, they have chosen to insulate themselves even more. As Kevin O'Leary from Shark Tank said, "Putting up fences around headquarters and providing their executives with more security is not the message the public needs to see."
As for my friend and colleague Jon Purdy, his comment regarding Medicare losing money and allowing people to save money on their own to use for healthcare, fat chance that will work. Most people are not that disciplined that they can do that, and that was the whole purpose for Social Security and Medicare in the first place: To ensure that people in later life would have a safety net to provide to them.
The problem is that Medicare was not set up to be a profitable entity, but the Medicare Part C plans were set up to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
12/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Robert Kornfeld, DPM
Dr. Jacobs’ definition of podiatry, should it be the majority opinion, will surely lead to the death of podiatry. If all we do is look at the foot, focus on the foot and treat the foot regardless of the underlying immune burdens (as if the foot is independent of the body it is attached to), we will surely be replaced by NPs and PAs in the coming years. We are already a profession that is slowly being usurped by these new professions. Dr. Jacobs and I are from the older generation that began the battle for parity through better surgical skills.
But will that sustain us? I say absolutely not. I feel that our schools need to provide more comprehensive training in what creates an inefficient immune system that is part and parcel of most of the pathology we treat. Are we not allowed to advance our skills once in practice? Or are we only allowed to practice what we learn in...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
12/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: All I Want is My Fair Share
From: Rod Tomczak, DPM, MD, EdD
“All I want is what I have coming to me. All I want is my fair share.” - Sally Brown in A Charlie Brown Christmas 1965
I’m not sure how I remember that quote from 59 years ago. Maybe a strange proclivity, or perhaps a suppressed prophetic tendency rearing its head at this most auspicious time of the year. The quote may be prophetic for our profession, maybe not. Regardless, we need to take a look.
After some critical introspection and meditation, I have come to the conclusion there are multiple podiatric phenotypes that cause us to scratch our heads and ask, “Quo tenditimus?” (similar to tendonitis but accurate as is) or “Where are we going?” Rather than use dentistry as an example, let’s use ophthalmology as...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
12/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Read the Fine Print
From: Gary S Smith, DPM
We were approached by a Rep from Samaritan Biologics, a company that supplies various biologic grafts. They presented us with a video and emails/text messages detailing that we would keep 40% of whatever Medicare approves for the material. We did order and apply a graft in the office. We were presented with a bill from Samaritan for 100% of what Medicare approves.
When we questioned this, the CEO called us and told us we missed the fine print where it says we pay 100% of what Medicare approves for the first 3 grafts in a month, THEN you get to keep 40% of the fourth! Obviously, nobody would order a second material from this company. I suggest anybody being approached by them to not purchase, or at least, read the fine print.
Gary S Smith, DPM, Bradford, PA
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