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04/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Wound Care Costs
From: Seymoure Balaj, DPM
When I queried AI about wound care costs, here's what came up. "Yes, recent data indicates that Medicare is now spending more on wound care, specifically on certain types of wound dressings than on ambulance rides, anesthesia, or CT scans. This shift is attributed to factors like Medicare's coverage of wound care in patients' homes and the increasing number of seniors. particularly those with diabetic sores, requiring these dressings."
Seymoure Balaj, DPM, Southfield, MI
Other messages in this thread:
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Paul Stepanczuk, DPM
Regarding Dr. Tomczak's recent letter looking for an honest man, PM News has apparently found 802 of them. Any prospective candidate for podiatry should be shown the results of PM News’ recent poll regarding the rendering of palliative care. In past issues, palliative care has been described as podiatry's little secret. It's really no secret to those who are in practice, and the amount a practitioner will need to do should not be kept from people who are interested in the profession.
Paul Stepanczuk, DPM, Tinley Park, IL
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth DPM, MPH
My highest accolades for Dr. Geistler opinions on the overuse and abuse of grafts being used in podiatry. He is right on, and I am proud to call him a true professional. I agree... throw the book at our fellow practitioners who are just milking the system for the dollars and really NOT helping the patients at all.
Ivar E. Roth DPM, MPH, Newport Beach, CA
04/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
I really want to thank Dr. Secord for his German compound word idioms. It plays precisely into the completion of defining podiatry. When I was 16, I still was fluent in German, attending a boarding school near Aachen. I still dream in German once or twice a month, but nowhere like it used to be. As a lone monk chants at the burial of as pope, “Tempus fugit, memoria mortem.” Time flies, remember death.
For quite some time, we have defined ourselves as the primary care givers of feet, especially for what we identify as sick feet. Let’s be honest, most of us don’t do reconstructive surgery on feet with multiple complex deformities and use external fixation. Orthopedic foot and ankle care givers don’t have time during their one-year fellowship to learn what we learn in seven years. If you want to make it a binary distinction, we take care of sick feet that have sometimes...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
04/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: David Secord, DPM
Once again, Dr. Tomczak helps focus upon the pivotal point in the progression of our fate. That he does so while being able to throw in a little modus tollens Aristolean syllogistic logic is that much more entertaining. It had been a while since I’d seen the term portmanteau, so kudos!
His description of our struggles to define ourselves before we can define what we do and who we are as a profession to the lay public as a synecdoche or metonymy rings true. Dr. Tomczak does a wonderful job in his musings as a erziehungsroman of sorts. We are truly, as a profession, writing a bildungsroman as we go. Hopefully, the story will end as a victory and not a tragedy. Change is inevitable. Our indecision to initiate and continue the journey is not encouraging.
David Secord, DPM, McAllen, TX
02/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Ivar E. Roth, DPM, MPH
Dr. Whelan is correct. Let’s take control of this situation. The writing is clearly on the wall; we as a profession have to move, and move fast to make sure we are in charge of any change. The students graduating today are not interested in routine care. It is sadly now a fact. Also, we have to lose the limited license aspect of our profession. We are so well trained, but can do less than a PA, nurse, or many other allied professionals.
The time is now. Who will lead the charge is dependent on our leaders, but the time has come.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
02/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Thomas A. Graziano, DPM, MD
Dr. Whelan brings up some salient points when addressing the concerns over the future of podiatric medicine. Many years ago, the foot was neglected by the medical community and podiatry came into its own by filling that void. The current requirement for EVERY podiatry school graduate to complete a 3-year surgical residency has fostered the neglect of routine foot care. And now that void appears to be filled by nurses or non-podiatric ancillary staff. History may be repeating itself.
In 41 years in practice, I've seen the gradual decline in the public's perception and the insurance industry's devaluation of healthcare professionals. We are no longer perceived as doctors. We are now looked at by the insurance industry and to some degree by the public merely as "providers."
The recent survey on this forum demonstrating that if given the choice, over 43% would prefer a career path in osteopathic medicine is not at all surprising. Let's address the elephant in the room. A good friend of mine whose son just completed a DO family practice residency accepted an offer of 350K/annum as a hospitalist. And this for an 18 day/month work schedule. Perhaps the survey results and paucity of podiatry school applications might have something to do with the disparity between podiatry and osteopathic medicine.
Whether one agrees or not as to why the profession of podiatric medicine is at a crossroads right now, there's no doubt the writing is on the wall. 300 applications to all the podiatry schools sends a clear message. Dr. Whelan's comments may not only be insightful but may be a necessity in the very near future.
Thomas A. Graziano, DPM, MD, Clifton, NJ
02/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Raymond S. Murano, DPM
Regarding foot care nurses doing foot care and wound care in the hospital setting as well as the home setting....they are filling a need left by new podiatrists who do not want to cut toenails. Are you serious? At my hospital, the administration dropped podiatry consults for nail care/calluses, to be done now on an outpatient basis because the younger podiatrists don’t want to cut toenails. So what happens when a patient is scheduled to be discharged to a SNF and requests that the toenails be cut before sending them over for an admission?
No podiatrists are available. So the family hires a nurse practitioner to go in and take care of the patient’s toenails so that she can be admitted to the nursing home. The nurse practitioner or RNs that I trained in diabetic foot care as well as wound care do an excellent job. These new RN nurse practitioners are coming on board. Our hospital will be supervised under my service. So there is a low number of applications for podiatry schools?
Raymond S. Murano, DPM, Medford, MA
02/21/2025
0RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Allen M. Jacobs, DPM
Dr. Roth has made the observation that some of the young residents and practitioners lack the drive and intensity to work longer hours and harder than his generation. Many of today’s younger doctors are smart and seek a much better work/life balance than did my generation. This is in my opinion a good thing not a bad thing. This generation wishes to reduce the stress and burnout that has afflicted so many healthcare providers in today’s world. The newer generation is not as motivated to generate maximum income, but rather maintain a good work balance while providing good care for their patients. They do not wish to engage in the long hours and sacrifices that our generation was taught to be part of being a doctor.
Work/life balance integration is important to many of our younger doctors. Older healthcare providers may not relate to this manner of thinking. However, younger doctors are anxious to limit commitment to being a podiatrist and set boundaries for their work hours versus...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/18/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
RE: Low Student Enrollment/American Foot Care Nurses
From: Richard Rettig, DPM
I read with interest the paradox between two separate topics that are being discussed simultaneously on PM News. We are reading that there are only about 300 TOTAL applicants to all podiatry schools. Some of them are certainly not qualified for acceptance, and some will not complete the four-year course of study. The application year is not over yet, but surely the trend here is that there will not be enough graduates to replace those of us who are currently practicing. As far as encouraging more applications to podiatry schools, the Pennsylvania Podiatric Medical Association, for one, has been beating that drum at the HOD and elsewhere for over 25 years.
The other topic is that there are nurses who have started foot care practices. This has also been ongoing for at least 25 years, but when a nurse opens up in someone's practice area, that doctor suddenly becomes acutely aware of the problem and starts a new 'OMG' discussion string on PM News. So the paradox is this: if we aren't going to produce enough podiatrists in the future, who do you think is going to do the footcare?
Richard Rettig, DPM, Philadelphia PA
02/18/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
RE: American Foot Care Nurses
From: Chris Seuferling, DPM
I cannot speak for the rest of the country (though I imagine most states have similar concerns), but I am well-versed in Portland, Oregon's podiatry and foot nurse dynamics. I am also familiar with Portland Foot Care Clinic and its CEO Amarachi, RN. In fact, we have had multiple conversations at the state level and national APMA level to address this issue… even introducing Proposition language at the 2024 HOD (see my proposed language below). It did not gain the traction I had hoped for, but I’m told it’s on APMA’s radar.
With that said, I ultimately feel it’s an “us” issue, not a “them” issue….i.e.; it is a “Podiatry Identity” crisis and not a “Foot Nurse competition” one. Many times during the course of the year, I have the following conversation with a new patient…"Mrs. Jones, I noticed podiatrist Dr. X performed your ankle fracture surgery. Why are you not seeing...
Editor's note: Dr. Seuferling 's extended-length letter can be read here.
02/17/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Allen M. Jacobs, DPM
Dr. DiResta appears to be somewhat concerned that a podiatrist is serving as an instructor in foot care for nurses. I wonder if orthopedic surgeons express the same concern to their colleagues who participate in podiatric medical and surgical education. After all, by doing so, you are aiding and abetting the competition (enemy), are you not? At the NYSPMA meeting this year, there were interactive panels with orthopedic surgeons, and a program in which dermatologists were instructing in the evaluation and treatment of foot and ankle dermatologic disorders. Should they have refused to do so over concern for decreased patient revenue?
Some years ago, Dr. James Ganley asked me if I would be comfortable teaching family medicine residents how to manage ingrown toenails and common foot problems. He told me that he regularly instructed non-podiatrists in the evaluation and treatment of common foot disorders. His reasoning made sense to me. First of all, he told me that...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/17/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Don R Blum, DPM, JD
Recommendation - please check with your state board of nursing to confirm whether or not this practice by an RN is within the scope of their license. Can they practice unsupervised? In their website under “what to expect”, they talk about 3-D imaging for orthoses. In Texas, there is a law specifying who may prescribe orthoses. Check your state “orthotic” law if you have one.
Are RNs allowed to prescribe orthoses in your state? Are nurses allowed to practice unsupervised to provide diabetic foot exams and diagnoses? Finally, are the American Foot Care Nurses billing insurance or is it strictly fee-for-service? Please do not just complain. Investigate what the state law is regarding nurse (RN) practice acts and scope of practice.
Don R Blum, DPM, JD, Dallas, TX
02/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: American Foot Care Nurses Association
From: Tyler Manson, DPM, Joseph Borreggine, DPM
Tyler Manson, DPM, Lake Oswego, OR
The APMA, I would opine, is totally fine with this? And, I assume so is the profession? We are the first line of defense when it comes to routine foot care. That’s nice. I would consider this to be an insult to the legacy of our profession. We are the primary foot care provider, period end of story! So, if we cannot get paid for “routine foot care”, then we just do not see the patient? Really?
So, just send them to a registered nurse? Really? That makes no sense. I guarantee that if a podiatrist were to truly do a foot examination on a patient who qualifies for routine care, other pathology would be identified with respect to any/all...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
02/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Gary S Smith, DPM
Dr. Jacobs brings up some great points as usual. A big problem with medicine and podiatry is medical school selection. If you aren't aware of this, you won't believe it, but it's true. Medical schools make so much money taking people on permanent SSI disability that some fill as many seats as they can with them, and then take a few of the best and brightest. Medical schools actually promise a seat to SSI students when they graduate from high school.
College is just a formality. Since they are disabled, many don't have to study, show up for tests and class in college. When they get to medical school, they have little education and no study skills. Medical schools had to compensate for this by creating "alternative pathways of learning" that allow them to grade students subjectively. Some of these people end up being great doctors. Some have severe mental or personality disabilities that prevent them from doing so. Medical residency is a lottery and once they are in, they can't be removed, so they just treat them like a mushroom, graduate them, and turn them loose on the population.
Gary S Smith, DPM, Bradford, PA
02/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Allen M. Jacobs, DPM
Dr. Roth laments his conversation with an individual in that allegedly, a graduate of a three-year podiatric residency had never performed a surgical procedure "skin to skin". He queries how this is possible.
Community podiatrists do not have an ethical or legal obligation to allow residents to participate in surgery on their patients. We must recall that patient sought the care of the attending, not a resident. Our first obligation when we participate in medical education is to always prioritize patient safety, not the education of the resident. A community podiatrist may determine that it is in the best interest of the patient to limit or not allow a particular resident's participation in a particular case. With that said, PM News readers know there is touch and sense to surgery that must be experienced and cannot...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Gregory T. Amarantos, DPM
Being recently retired, I am volunteering alongside Dr. Roth. For the past few weeks, I have read the posts and I believe the issue is multi-faceted. Forever the cynic, I follow the money. Where to start? Too many schools with too few candidates, thus the schools admit less qualified applicants, in turn, less qualified physicians and surgeons. Hospitals want the residency programs because they are a cash cow. All the different boards want your money so you can show you are board certified and capable of doing surgery. We all know colleagues who should never hold anything but a #10 blade to do C&C. Then let’s get to the APMA which for the past decade has shoved diabetic foot care and wound care down our throats as if that is all we are capable of doing. Follow the money; the wound care companies co-sponsor meetings.
Of course, the practicing podiatrists themselves have contributed to the lack of awareness of our profession as "everyone" qualifies for Medicare coverage. Why are so many afraid to tell the patients the truth... you do not qualify for this service and the fee is...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
02/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Lawrence Rubin, DPM
Dr. Roth speaks words of wisdom when he implies that APMA should not be chided for inaction in helping members compete for patients in our present multi-provider crowded foot healthcare marketplace. Medical associations are all limited in what they can do by antitrust policies that prevent them from engaging in potential anti-competitive practices.
But that does not mean that podiatrists cannot do what other medical associations do when they support the formation of third-party independent practice associations (IPA) that create value-based standards of care and market their members to the public and insurance payers. There are legal requirements, but, for example, optometrists, dentists, and primary care physicians have profited from supporting the creation of specialty IPAs for many years.
Lawrence Rubin, DPM, Las Vegas, NV
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
02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Oloff, DPM
Why are applications down? Everyone who has weighed in on this is correct: too many schools, lack of identity, competition, costs, etc. Everyone who has suggested solutions is also correct: profession, schools, practitioners all need to reach out more for effective recruitment. The problems and solutions are multifactorial. How do you fix this? I don’t think you can close schools, however economics will eventually solve this problem. I do not think that all the schools will survive economic downturns forever.
I was talking to a businessman recently about this. His perspective was not what I expected. He began to cite the supply and demand curve. He thought if the supply of podiatrists went down and the demand was the same or greater, then the salaries of podiatrists would likely go...
Editor's note: Dr. Oloff's extended-length letter can be read here.
02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Lee C. Rogers, DPM
I have read the comments from my colleagues with interest. I would point out that this is a topic that has received much attention from the profession's leadership and deliberative bodies. It has been addressed at the APMA House of Delegates in the past several years and it is discussed at almost every BOT meeting. The APMA has been taking action to increase the number of applicants. While it is not the APMA's "job" to boost school enrollment, the APMA (and its components) fully understands the connection between reduced qualified applicants and reduced membership and the imminent threat to the profession.
The APMA has raised money to help better the brand of podiatry as a career choice through a separate foundation. Certainly, the entity primarily tasked with increasing applicants and enrollment is the AACPM. They have also taken this threat seriously and started the "Feet on the Street" campaign, funded by...
Editor's note: Dr. Roger's extended-length letter can be read here.
02/07/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jon Purdy, DPM, Elliot Udell, DPM
Dr. Jacobs makes some poignant and comical statements as usual. In my humble opinion, he is one hundred percent correct. I have always introduced myself as a podiatrist. Being an expert does very little in the arena of managed care unless you are well known as “the” expert. Patients are more than willing to accept insurances that don’t cover their needs and are, more often than, not oblivious to the fact they are receiving sub-par medical care in the hands of alternative providers.
With all that is happening to our profession, both in our hands and the perceptions of the medical community, Dr. Jacobs has further made the point for us to obtain a medical degree with a sub-specialty in foot and ankle.
Jon Purdy, DPM, New Iberia, LA
In the midst of all our downhearted comments about why our colleges are not doing well, a young college student called my office and asked to visit because she is interested in becoming a podiatrist. I welcomed her with open arms and will also arrange for her to shadow other colleagues who are more surgically oriented. Based on my conversation with her, I am positive that she will be a student at NYCPM.
Elliot Udell, DPM, Hicksville, NY
02/06/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Allen M. Jacobs, DPM
Recruitment? It is indeed a sad day that our colleges have been compelled to develop strategies to enhance student recruitment efforts. It is depressing to hear a call for practitioners to make efforts to recruit students. PM News readers have expressed an eclectic universe of explanations proposing the etiology for the lack of interest in our profession. Many if not most of these explanations are reasonable, and perhaps the sum total of all of these propositions explains the current disinterest in podiatry among college undergraduates. Facts are what they are. There is a demonstratable lack of interest in pursuing a DPM degree. The numbers speak for themselves.
There is no issue that the services provided by a podiatrist are needed. The issue is whether a podiatrist is needed to provide those services. As other PM News contributors have noted, services provided by a podiatrist may be provided by orthopedic surgeons, general surgeons,...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/06/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Rod Tomczak, DPM, MD, EdD
Since late 2022, I have been submitting letters to PM News and Dr. Barry Block has graciously been publishing them for the profession to read. There have been two main topics my submissions have fallen into; 1. The issue of board certification and the ramifications between the haves and have nots and; 2. The severe decrease in the number of students in the podiatry classes at the eleven schools.
An honorable source who has nothing to gain by lying has informed me that as of last week there were approximately 300 applicants to all the podiatry schools. This may not include the Texas school in El Paso which has its own application service outside of AACPM. The number 300 refers to applicants going through AACPM. Schools offer acceptance and seats. We have been trying to tell the profession that there won’t be a need to address the first topic of conversation, board certification soon. There won’t be anyone to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
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
02/05/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Chuck Langman, DPM
My take as someone who is closer to retirement than just starting out is a little nuanced as we can only see life through our own eyes. I did a one-year surgical residency in the 1980s. I came out being comfortable and proficient with forefoot surgery. As I did more surgery, I realized I wasn’t in love with it (and you need to be in love with it to be great at it). I kept only to the procedures I was comfortable with and never ventured out of my comfort zone. I enjoyed far more the people I was able to keep out of the OR and the athletes I treated conservatively. Fast forward to when I was about 50 years old and was lucky enough to join a very large orthopedic group that allowed me to be non-surgical and do orthopedics and sports medicine all day.
I truly love what I do! I have a team of surgical podiatrists and fellowship-trained foot and ankle surgeons to refer to for the cases that need surgery. I also note that we have a large team of...
Editor's note: Dr. Langman's extended-length letter can be read here.
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