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02/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ivar E. Roth, DPM, MPH
I agree with Dr. Feinman. It does appear that today’s graduates look to lifestyle and convenience as their priorities. I remember when I was so thirsty for knowledge. The competition to get a residency, which only 50% of the class got was what caused us all to be very competitive. Now everyone is guaranteed a residency and so complacency seems to have taken hold with a good number of the graduates.
I have recently interviewed candidates for an associate position, and I can tell you most of them are just looking to work the bare minimum 40 hours a week with no intention or drive to work more hours or harder than the minimum required. Needless to say, I have been disappointed.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
Other messages in this thread:
02/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: David Secord, DPM
Although I agree that the future of the profession is plenary licensure, I’m confused as to why there would be a push to obtain a degree as an osteopath with a podiatric sub-specialty, as opposed to obtaining a degree as an allopath with a podiatric sub-specialty? 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 a few others.
Allopathic medical theory has as its basis the idea of pathology from disease state: bacteria, virus, spirochete, genetic dyscrasia, prion, etc. Unless I missed something critical in medical school, that’s the disease model we in podiatry follow as well. As such, podiatric medicine IS allopathic medicine. As we don’t follow the osteopathic theory of medicine, why would we obtain degrees as osteopaths, practice as allopaths, and so muddy the waters? I’m finding this very curious.
David Secord, DPM, McAllen, TX
02/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
I ask everyone who replied to this week's survey concerning options for undergraduates interested in healthcare to read my extended letter concerning the possibility of a DO degree and a commitment to foot and ankle care without a DPM degree. The PM News of 02/15/2025 and 02/17/2025 are intrinsically attached to the survey and the current DPM population.
It is important that everyone who participates in the survey understands this could be the end of the DPM degree and podiatry since there will not be a podiatry degree but merely a new medical/surgical specialty called podiatry. Although APMA could exist just like the AAOS exists, APMA would not be the same organization.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
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
02/04/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Aaron Solomon, DPM
I am in 100% agreement with Dr. Hinkes. However, to tell students the 'Why', pre-medical students need to know who and what we are. Of course, we are an important profession and as our population ages, the need for our services increases. Sharing this with would-be physicians is extremely important, but it comes with educating these young students as to who we are. I believe, based on my own individual experiences, that there are few high school and pre-medical students who know who we are.
If pre-medical students do not know we exist, we cannot tell them why they should join the profession. I certainly do not want to diminish why an individual would want to be part of our profession, based on their desire to help people. It is incumbent upon us to show these pre-medical students all the good we do as it would address the ‘why,’ ‘what’ and ‘who.’ My hope would be to generate enthusiasm by showing high school and pre-medical students who we are and what we do. It is important to share interesting cases from the operating room and the office. It is important to let people know that it can be a fruitful endeavor for them to become podiatrists. I am certainly not trying to make this a discussion about money, but when people do decide what it is they want to do for a living, financial stability is part of the decision.
Aaron Solomon, DPM, Fort Oglethorpe, GA
01/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: John Clyde, DPM
Case in point is on the APMA Career Center. Three of the five featured podiatry job postings are for nurse practitioners, and the one with a published salary is higher than most of the published data on average podiatrist salaries.
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APMA Featured Jobs |
Why take on all of the podiatry school debt and the massive responsibilities/liabilities of being a surgeon when you can work while getting your advanced degree, and then step into whatever specialty you want with a good salary and benefits with little to no experience and little to no consequences? And based on this ad, no cutting toenails!
John Clyde, DPM, Spokane, WA
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
01/01/2025
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
11/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Allen M. Jacobs, DPM
Dr. Roth expresses his "disgust" at the treatment of plantar fasciitis by a colleague. He opines that the "younger podiatrists" are motivated by money rather than patient well-being. He states that the patient consulted with an insurance covered podiatrist rather than "me", (that is) Dr. Roth. What was most disconcerting to me was the statement that Dr. Roth reviews anything for the purpose of making a judgment on the necessity of care and, hopefully not, standard of care.
Dr. Roth is critical of the utilization of ECSWT for the treatment of plantar fasciitis. In point of fact, while I personally do not employ ECSWT due to the general difficulty in obtaining insurance coverage for this modality, it is an acceptable and not-infrequently utilized modality for the management of plantar fasciitis. There is reasonable literature support for this modality in the management of...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
10/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Howard Bonenberger, DPM
Everything is related to the perceived value brought to the table. In their minds, a degree which is universally recognized by the public, VC firms, or other businesses, the MD (DO) can author research on the entire body. The DPM has limited scope which can be covered by orthopedic research, at least in their minds.
Perhaps submit research that is blind as to the authors' names and degrees. It would not be for actual publication but to have it read by someone who is curious. If of high enough quality and the publication inquired, then it would be revealed that the author(s) were DPMs. I may be way off base, I'd appreciate thoughts on this idea.
Howard Bonenberger, DPM (Retired), Nashua, NH
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
10/05/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Irv Luftig, DPM
Although it may be a good thought to unionize physicians, podiatrists, dentists, etc., it's a really bad idea. It was a tactic used by various medical groups a few times up in Canada and each time ended quickly as a miserable failure. There was absolutely zero support from the general public. There was palpable outrage from the public. Simply put, doctors (MDs, DOs, DPMs, DDS’) are perceived as wealthy because "we all make hundreds of thousands of dollars."
The public doesn't care about overhead, salaries, etc. Most people make $50,000 or less, maybe a bit more. You will be viewed as greedy, wealthy, uncaring, and if you withhold services in a strike, then watch out for the swift reaction from politicians and the public. Politicians will make mince meat out of you and the public will hate you. It won't be pretty and you will potentially be losing your patients' trust for years.
Irv Luftig, DPM (retired), Toronto, Ontario, Canada
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jon Purdy, DPM
Regarding the post from Dr. Tomczak, I did find that very amusing. I don’t intend to do a back and forth on this, but suffice it to say, I never put someone’s name in print without their permission. I’m sure that person would have been fine with it had I asked.
All associations post-covid have struggled, which necessitated change. As treasurer of the American Academy of Podiatric Practice Management, there has been change required of our own organization. We welcome constructive criticism, as it helps us improve and grow. It’s no different for the APMA. Time will tell, but I like the vibe they are currently putting out, and its leaders seem to be in tune with positive change.
Jon Purdy, DPM, New Iberia, LA
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
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Kathleen Neuhoff, DPM
Sadly, I must agree with Dr. Doms. I was president of the American Animal Hospital Association years ago and we investigated the cost of such a campaign. It was many millions of dollars. At that time, there were about 50,000 veterinarians. It would have required a donation of more than $500 each if EVERY veterinarian contributed. We polled our members and the average they were willing to contribute was $100. And we knew from PAC contribution records that less than 10 percent would actually contribute, so it was not feasible.
The advertising we have been able to do has been primarily supported by our vendors but I suspect the amount of money spent by clients for products such as pet foods, cat litter, flea products, etc. far exceeds the amounts spent by our patients for podiatric-related products. It is certainly possible that some of the podiatrists reading this would be happy to contribute $1,000 each year for a PR campaign, but I suspect most would not.
Kathleen Neuhoff, DPM, South Bend, IN
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Howard Bonenberger, DPM
I cannot agree more with Dr. Jacob's letter. I feel secondary embarrassment when reading a post, presumably from social media or print material, quoting a podiatrist about foot odor, Dante's flip-flop hell, shoe selection, and ingrown nails.
I experienced something that may be partially at fault: years ago a local writer asked for an interview. She came with a list of questions which would have produced the very subject matter we are denigrating. I realized that she knew little about our training and skill level. I walked her through a typical week of sports injuries, fracture care, office and hospital surgeries, diabetic care, and C & C. She was a little embarrassed and very grateful for the eye-opening education. She actually became a patient and referred many others over the years.
I suggest that when asked to be interviewed for an article, podiatrists provide a thoughtful, short summary of a typical week and educate the interviewer. Plan ahead, please use spell check and proper grammar. Send them to various health news outlets. I have never read an interview with an orthopedic foot and ankle doctor who is discussing buying junior's shoes. It is because the interviewer would never deem to insult them with such lowly questions, after all...they are seen as well-trained physicians and surgeons. Until we, as a profession, set the table of expectations, not much will change.
Howard Bonenberger, DPM (Retired), Hollis, NH
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jerry Peterson, DPM
No, you are not missing something. He should be able to assist ANY physician on ANY surgery. In Oregon, a podiatric physician can assist in general surgical procedures, Ortho, Neuro procedures, etc. They are not required to have the privileges to be able to assist. Good luck moving forward.
Jerry Peterson, DPM, West Lynn, OR
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Bret Ribotsky, DPM, Lawrence A. Santi, DPM
I’m eagerly awaiting APMA’s response to this issue before I send my check. Please choose wisely.
Bret Ribotsky, DPM, Fort Lauderdale,, FL
APMA values every member and their input, and we apologize to any life member who may feel disenfranchised by the current referendum. As background, eligibility to vote in a referendum is codified in the APMA Bylaws for each member category—the APMA Board of Trustees and staff cannot simply choose to allow life members to vote. The Bylaws, Procedures, and Rules Committee reviewed the privileges afforded each member category as part of its comprehensive review of APMA’s governance documents and included the current privileges that were adopted by the 2019 House of Delegates. Life members are not the only category of members who are ineligible to vote. For more information on eligibility, check out our FAQs about the referendum at www.apma.org/referendum.
The philosophy of the committee has been that members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum. So, life members, who are retired from practice, would not be affected by language designed to support scope of practice modernization.
I have heard your concerns, and the Bylaws, Procedures, and Rules Committee will consider the feedback we have received from life members at its fall meeting. To be clear, changing the bylaws would require action by the APMA House of Delegates, so any changes will take time. I thank you in advance for your patience and understanding.
Lawrence A. Santi, DPM, President, APMA
Editor's note: This topic is now closed.
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Stephen Musser, DPM
I disagree with your daughter's school decision. If the state where her school is located includes podiatry in the definition as a physician, then I think you or your daughter can argue/refute the administration's decision. I once had an MD/DO point out to me that I shouldn't be parking in a physician designated parking spot. I politely told him I am considered a physician in the eyes of the Ohio medical board and left my car where I parked it. Nothing came of it and nothing more was said.
Stephen Musser, DPM, Cleveland, OH
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Hal Ornstein, DPM
I highly recommend Mike Crosby, CPA of Provider Resources as a practice appraisal expert. He has performed this service for hundreds of podiatry practices and been doing this for many years. He is responsive, knowledgeable, and fair to all parties involved.
Hal Ornstein, DPM, Howell, NJ
05/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Greg Amarantos, DPM
I find it interesting how a post can be interpreted from a different lens and diametrically opposing conclusions are reached. In reading Dr. Tomczak's response to Dr. Roth, I read Dr. Roth's post differently.
While we should believe we are providing the best possible care, we have to face the facts; in private practice, our treatment protocols are at least partially driven by the insurance company policies. I do not read any impugning of the profession. Dr. Roth should believe he is providing the best care, as should you and I. Cash frees the practitioner from the shackles of the insurance company policies. Think of the man hours used on "meaningless use/MIPS" and the like. Dr. Roth reminds me that medicine made a deal with the devil years ago and...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jeff Root
You might want to consider using Quicken Classic Business and Personal if your accounting needs are fairly basic as you suggest. I believe the annual subscription fee is around $120 and costs about half that for the first year. You can set up custom income and expense categories and run income and expense reports that should satisfy your basic accounting needs. You might even be able to import some of your historical data from Quickbooks but you should check with Quicken or Quickbooks support about that first. I have been using Quicken for my personal accounting needs since the 1980s and used Quickbooks for business purposes for many years. I have been very satisfied with Quicken and they have excellent customer support.
Jeff Root, President, KevinRoot Medical
03/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Connie Lee Bills, DPM
We started this about a month ago. Patients are more likely to pay cash or check when faced with a 3.5% fee. My optometrist started it about two months ago and spurred me to follow suit.
I checked with the local credit union and they said HSA cards can be used for the fees as long as they are from a healthcare registered facility. Everyone should be doing this.
Connie Lee Bills, DPM, Mount Pleasant, MI
03/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Robert Scott Steinberg, DPM
"A significant portion of the older podiatric profession are the notional progeny of chiropodists. For many of us, the first exposure to our future profession was afforded by individuals with the letters DSC behind their names." - Tomczak
I highly doubt your statement to be true. Where did you get your statistics? I do not believe there are many 80+ year-old practicing DPMs in any leadership roles in their state or the APMA. If there were, things would not be so messed up!
Robert Scott Steinberg, DPM, Schaumburg, IL
11/22/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Alan Bass, DPM
I recommend Mike Crosby with Provider Resources. Mike is a CPA and has been in and around podiatry for as long as I can remember. I know that he has helped dozens of our colleagues value their practices in preparation for sale. He also works with DPMs to decide when it’s time to bring on an associate, or value the practice if moving an associate to partnership.
Alan Bass, DPM, Manalapan, NJ
11/21/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Richard M. Cowin, DPM
For a practice valuation, I highly recommend Mr. David Price at Podiatry Broker. He offers three (3) levels of service for three (3) different prices: $395.00 for a ballpark evaluation, $995 for an off-site evaluation, and $3,995 for an on-site evaluation.
Richard M. Cowin, DPM, Orlando. FL
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