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02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Gary S Smith, DPM
The three-year residency has killed podiatry. My son was going to become a podiatrist and I talked him out of it. I told him it is silly to do a three-year residency just to be limited to surgery of the feet and cut toenails. The three-year residency used to be held in very high esteem. Now, it's like a high school diploma. Everybody gets one and it has become meaningless. The idea was to improve parity and our reputation, and it has done neither.
I have hired many podiatrists over the last 30 years and there is a big problem with these residencies. It used to be if someone did a 2-year surgical residency, then you had somebody that really knew their stuff. A top-notch surgeon. Now, I'm seeing three-year residency graduates that can't even do a matrixectomy competently.
Prospective applicants ask me, "will you help me do surgery?" The worst part is they can get privileges I can't because of their 3-year program. Some can't do hammertoes. Some have communication skills that would not allow them a job at the drive-through. Many take three hours to do a bunion. 20 years ago, if you asked staff at most hospitals, "who is the best surgeon," they would answer a podiatrist. Now I hear from staff at some hospitals that the podiatrist is a joke. The problem is that when one of us is "a joke", we all are. People group us all together. I don't know what the answer is.
Gary S Smith, DPM, Bradford, PA
Other messages in this thread:
02/05/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Alan Sherman, DPM
I have a few more thoughts on the future of podiatric residency education. As far as the dual track for residency education....It wasn't a popular option 2 years ago when I proposed it, but timing is important and maybe its time will come soon. I just hate inefficiency and waste, and I feel so much time and effort is being wasted on training residents in surgery that most will not likely use. Their cases should go to the few residents that are suited to become specialty orthopedic surgeons of the foot and ankle. I also hate pretense, but love transparency and honesty because it leads to trust and comfort. We want to be trusted as a profession.
We are podiatrists and that brand has gotten better through the years. That we aren't using the brand name is, I think, just dumb and a lost opportunity. The public is beginning to understand the name podiatry and what it means. I've always felt that patients may get a second opinion from persons who calls themselves foot and ankle surgeons, but surgery is seldom why they go to any doctor to begin with. They don't see a sign that says foot and ankle surgeon and think, I want some of that. They go to a podiatrist to obtain relief from their symptoms, to feel and perform better, and surgery isn't any more their first choice than it should be the doctor's.
Alan Sherman, DPM, Boca Raton, FL
11/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Jack Ressler, DPM
I've been reading a few of the comments posted by fellow podiatrists addressing a query written by Dr. Roth. Next month will be two years that I have been retired so I can say I do not have any "skin in the game" concerning Dr Roth's query. There have been some strong negative and sarcastic comments posted by several podiatrists.
I cannot vouch for Dr .Roth's expertise about insurance companies but suffice to say, if PM News posted a poll question asking if podiatrists had the option of seeing patients on a cash basis versus taking their insurance, I think we all know what the answer would be. After practicing for over 35 years and having the headaches of audits, fair hearings, non-paid services, deductibles, and more, I know what my answer to that poll question would be!
Jack Ressler, DPM, Boca Raton, FL
05/23/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Steven Selby Blanken, DPM
Dr. Tomczak's note was very well written about the actual situation that ABPM created. It is quite interesting to see how somebody who would’ve done a one-year surgical residency and left the country for various reasons, can come back and not get certified through another pathway from a board that offers others a certificate of qualification in surgery, but will not enable him to do the same. This is a perfect example of how things are wrong in our profession. I was once certified by ABPM and when they kept on changing their names as they became different boards, they randomly grandfathered certain people who already had certificates versus others.
It was quite surprising to see over the last month or so that five ABPM board members voluntarily resigned with the assignment of new board members, but there was no vote from the people who are certified by this board. Obviously, when five board members resign at the same time, it suggests they were asked to or they would be let go by the president of that board. The fact that our association had a statement out last week stating that it appears that the discussions between the two boards with APMA‘s help has stalled, and may not continue, is extremely worrisome. Well said, Dr. Tomczak. It explains how ABPM is really not legitimate in trying to be fair.
Steven Selby Blanken, DPM, Silver Spring, MD
03/24/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Ivar E. Roth DPM, MPH
I agree that having a DPM degree does NOT mean that you essentially can become board certified in surgery. Let’s face it... for various reasons, the bottom portion of the graduating podiatric medicine residents probably just do not meet the criteria. While an equal opportunity should be afforded to all to be boarded in surgery, the reality is that a certain percent of recent grads are not going to pass the exams or fulfill criteria for one reason or another. Developing a certification by an alternate board to basically allow any DPM to be “certified” in surgery is plain old wrong. While the easy way is always popular, that does not make it the correct way.
ABFAS must stand strong and reject any compromises as there really are none. The alternative board is attempting to grab money and power with its alternative surgical certification. For those who can NOT meet the requirements to become certified in surgery, call it a day. This current situation is no different mentality-wise to those who believe that everyone should receive a trophy (board certification in surgery) for participation, i.e. completing a residency in podiatric surgery.
Ivar E. Roth DPM, MPH, Newport Beach, CA
09/30/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Bret Ribotsky, DPM
It’s time for ONE BOARD CERTIFICATION. It has been over 20 years since I was president of ACFAOM (now ACPM), and I sit on the sidelines wondering what’s the overwhelming purpose to a CAQ in surgery? As I was board-certified in both surgery (ABPS) orthopedics (ABPO) and medicine (ABPOPPM), I recognize that most systems have flaws and our certification process is no exception. There are many people, while in their residency, who have logged cases that they did not personally perform, and I can go on and on with our dirty laundry; but, what’s the purpose? For years, the Holy Grail of success has been ABPS (now ABFAS) certification. But over the last decade, our education model has changed, with three years of residency training across the country and post-fellowships for added information beyond this point. It’s time for change.
I believe Lee Rogers is an honorable, bold, forward-thinking leader in our profession who is scratching an itch that we all have. It’s time for one board certification for our profession. One board will allow CAQ in different areas of expertise while eliminating the problems with third-party payers, hospital staffs, and political foes. Who’s brave enough to agree?
Bret Ribotsky, DPM, Fort Lauderdale, FL
06/25/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: W. David Herbert, DPM, JD
Over two hundred years ago, Thomas Jefferson predicted that judges would become little dictators. If we are talking about the standard of care in a medical malpractice case, one of these little dictators will be the one who will be in charge of who will be allowed to testify regarding the standard of care in any malpractice case. In some states, a non-doctor can testify about the standard of care of a doctor.
You also must remember that becoming a judge really depends on your politics and has nothing to do with your knowledge of science or medicine. Just something to consider when discussing standard of care.
W. David Herbert, DPM, JD, Billings, MT
02/08/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
RE: It's Time for Parity with MDs and DOs
From: Robert Scott Steinberg, DPM
Parity starts with the colleges of podiatric medicine teaching the same courses MDs and DOs are given. Case in point: For a number of years, the Illinois Podiatric Medical Association has tried, on behalf of the profession, to get the Scholl College of Podiatric Medicine (SCPM/RFU) at Rosalind Franklin University to teach gynecology, psychology, and pediatrics courses. These courses are the only ones missing for DPMs to be on par with MDs and DOs. These courses are taught to the students of the Chicago Medical School (CSM) at Rosalind Franklin University. How hard would it be to allow podiatry students to attend those same courses?
The administration of SCPM/RFU has, for all intents and purposes, deliberately blocked these courses from being taught to podiatric medical students. It is my opinion that what may be happening is the CMS is blocking it and RFU is going along. Four years at SCPM costs $170,000. The students at the SCPM are receiving a substandard education and deserve better.
In 1972, the Illinois College of Podiatric Medicine students walked out of school for two months, demanding a modern podiatric medical education. We were successful. Had we failed, there would not be a Scholl College of Podiatric Medicine! Time for change is painfully long overdue. Being nice has not worked.
Robert Scott Steinberg, DPM, Schaumburg, IL
10/09/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Jack Ressler, DPM
Dr. Dananberg brings up an excellent point with the experience he described. There are some very important points we can all learn from this encounter. First, and most important, is for the doctor to understand any underlying circumstances that could be involved in the patient’s life that may be causing their behavior. Understanding this can lead to a wonderful professional patient relationship that not only could last for years, but also lead to many referrals. I have had countless experiences as described by Dr. Dananberg. New patient protocol in my office involves having one of my assistants take the patient into a treatment room after they have been registered.
A brief history is done, followed by my assistant conferring with me before I go in the room. During our talk, my assistant will sometimes comment as to the patient’s condition, mood, or personality "quirks". This is of utmost importance because it is a signal to me that extra care or compassion is needed. I love to make patients laugh and feel comfortable. My goal is to have a patient leave the office feeling good both physically and mentally. Losing spouses or dealing with...
Editor's note: Dr. Ressler's extended-length post can be read here.
08/13/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Bryce Karulak, DPM
In response to Dr. Hecht’s comments, it does not matter whether or not we practice allopathic medicine. Most DOs practice allopathic medicine. What matters is MDs’ perceptions of us. They don’t see us as equals and they don’t bother many times to inform themselves of our training. When I spoke of allopaths, I was merely differentiating between MDs and DOs. Allopath and Osteopaths. Every osteopath I have encountered has been more open to what I offer.
I have successfully reconstructed patients when a foot and ankle ortho in the area said nothing could be done for the patient. The ortho told all those patients to come back when ready for a BKA. However, referral patterns do not change. The allopaths are aware of my success but again, they protect their own. Our profession frankly does not because we don’t agree on what we are and how we fit in and serve in medicine. This disagreement affects younger practitioners with extensive training.
I serve on a credentialing board and I see the difference between the way MD/DOs are treated and the way everyone else is. It’s is not the same. We are too small of a profession to make a significant path of our own. The only way forward is to join allopaths and osteopaths.
Bryce Karulak, DPM, Fredericksburg, TX
09/18/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Dale Feinberg, DPM
Dr. Borreggine’s excellent analysis of the future of podiatry hit the nail right on the head. He had been prognosticating that the demise of private practice was coming and now he has put out the word that private practice is dead.
I started reading the tea leaves about seven years ago when the implementation of Obamacare started affecting my practice. Denial of payment for the medically necessary diabetic shoes was the opening shot in the war with...
Editor's note: Dr. Feinberg's extended-length letter can be read here.
07/04/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Jessica Tabatt, DPM
Thank you, Dr. Bellezza, for showing us that there is still an unfortunate stigma surrounding mental health that prevents people from seeking the care they need. If a person is stressed, you cannot tell them that they are not, nor should they not be stressed. This would be like telling me that I am not hungry because you are not hungry.
I took my residency and now my current career seriously. Even though my patients are not dying, I still have their health and well-being under my care, which can be very stressful at times.
Jessica Tabatt, DPM, Brainerd, MN
07/03/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Samuel S. Mendicino, DPM
I find it sad that in discussing the suicide issue, people are arguing that our residents do not suffer the same stress as other residents and therefore this is not a concern. Does it matter? One is too many! Having someone say that a resident “should be happy” because they are doing what they “signed on for” demonstrates a common theme in our country: mental health and illness is not understood or for most even a concern.
I have had family members and friends who have attempted and committed suicides. Even in the absence of a suicide, depression and other forms of mental illness affect many Americans. It can be the cause of many of our nation’s problems. Crime, drug addiction, alcoholism, gun violence, homelessness, ruined lives, and yes suicide can often be traced back to mental health issues. Having dealt with the mental health system, I can assure you that it has severe flaws.
Residents have more stress than just residency. They have the same stresses of student loans, family, career, and yes some have a genetic predisposition to mental health issues as MD or DO residents do. Remember, mental illness is a disease that is often chronic and no different than diabetes or hypertension. It often requires lifetime treatment and can have a devastating effect on the patient and their families.
Samuel S. Mendicino, DPM, Houston, TX
01/27/2017
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Paul Stepanczuk, DPM
I have performed many punch biopsies for nerve status over the last several years. I have never had a cellulitis problem or even delayed healing. Betadine prep is utilized and patients are given instructions for daily care until the area is fully healed.
The reimbursement is low; the biopsy is not performed for reimbursement. Instead, I use it to see if something as potentially costly as Metanx would be warranted over an extended period of time.
Paul Stepanczuk, DPM, Munster, IN
07/01/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
In response to Dr. Joseph Borreggine's comments about podiatry being an "unnecessary" profession and that hospitals have no desire to hire podiatrists, I am a hospital-employed podiatrist, as are many others in my area. I currently practice with 40 other providers including PCPs, neurologists, and general/orthopedic/GI/neurosurgeons. I perform very limited "routine foot care/nail care", maybe 2-3 patients per day out of 30. The main focus of my practice is the day-to-day things we all see, including fasciitis, neuromas, paronychias, etc., as well as a very strong surgical practice (8-10 per week).
I consistently rank in the top 3 producers in the group and typically rank as the number 1 producer in the group at least 6 months per year. So, with all due respect, I have to completely disagree with Dr. Borreggine's comments. I think hospitals will quickly find us very valued and welcomed team members once they are aware of our capabilities and realize that not all of us want to make our living selling patients unneeded crap out of our provider-owned retail stores. I personally feel there is a very strong future for podiatry in the hospital era of medicine.
Name Withheld
04/29/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Dieter J Fellner, DPM
First, I want to thank the anonymous poster for instilling a sense of reality, common sense, and hope, with his contribution to this debate. Now, on to Dr. Sullivan. Please be assured I was wide awake when I read your response. And I am sorry that you seem to struggle so much in making ends meet towards the end of your career. It is possible, perhaps, that you might have benefited from the advice of our anonymous poster.
As for the source of my data, I will refer you back to my original posting. Seemingly, you found yourself in a state of indecent haste, and hurried to pen your righteous rebuke, but failed to read and/or comprehend the...
Editor's note: Dr. Fellner's extended-length letter can be read here.
04/28/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Marc Katz, DPM
I think there are a few important points to make. I think the profession has issues with schools putting students over 300K in debt and presenting misleading information about the earning potential of podiatrists. That needs to be addressed by the profession.
Here is my advice. Everyone needs to stop complaining and take responsibility for their career choice. We all chose this profession. If you did your research, here should be no surprises. You need to make the best of it. Everyone is complaining like they have such terrible lives, its not true.
Many podiatrists will not make more than a nurse, NP, or PA ever. A few will make millions. This is not...
Editor's note: Dr. Katz's extended-length letter can be read here.
02/10/2015
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Joel Lang, DPM
The answer to this dilemma is relatively simple. You cannot base your office policies on the unreasonable reactions of one patient who has run off the rails. Your policies should be based upon and consistent with your community standards, the needs of the patients you serve, and the best business practices that allow you to run your office successfully.
Nearly two weeks ago, I had a hospital surgery (as a patient) with an overnite stay. On my arrival at the hospital, the receptionist informed me that my copay would be $1,700. “How would you like to take care of that?” followed in the conversation. I actually got a call from the hospital 24 hours prior to admission telling me that my copay would be $1,700 – just so I would know!
When I was in practice, I had a financial policy form, written in plain language, which explained to all new patients how finances would be handled. I even had them sign it, acknowledging that they understood and agreed. I don’t think there were more than a few patients over the years who seriously objected and left. Many commented, but did not object. When questioned, I explained that the policy eliminated future misunderstandings. As a result, my accounts receivables, outside of insurance claims, were practically nil. Patients know that the economics of medicine has changed and continues to change. They will have to change with it.
Joel Lang, DPM (retired), Cheverly, MD
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